Provider Demographics
NPI:1851716823
Name:KASPER, KAITLYN (PAC)
Entity Type:Individual
Prefix:
First Name:KAITLYN
Middle Name:
Last Name:KASPER
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:KAITLYN
Other - Middle Name:
Other - Last Name:THOMPSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PAC
Mailing Address - Street 1:PO BOX 785482
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19178-5482
Mailing Address - Country:US
Mailing Address - Phone:866-955-6774
Mailing Address - Fax:781-276-6410
Practice Address - Street 1:1572 WILMINGTON PIKE
Practice Address - Street 2:
Practice Address - City:WEST CHESTER
Practice Address - State:PA
Practice Address - Zip Code:19382-8371
Practice Address - Country:US
Practice Address - Phone:610-459-8167
Practice Address - Fax:781-276-6410
Is Sole Proprietor?:No
Enumeration Date:2014-02-27
Last Update Date:2014-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA056746363A00000X
PAMA056745363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant