Provider Demographics
NPI:1881040590
Name:ARSENAULT, KACIE (PA-C)
Entity Type:Individual
Prefix:MISS
First Name:KACIE
Middle Name:
Last Name:ARSENAULT
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:77 HOSPITAL AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:NORTH ADAMS
Mailing Address - State:MA
Mailing Address - Zip Code:01247-2538
Mailing Address - Country:US
Mailing Address - Phone:413-663-6769
Mailing Address - Fax:
Practice Address - Street 1:77 HOSPITAL AVE STE 200
Practice Address - Street 2:
Practice Address - City:NORTH ADAMS
Practice Address - State:MA
Practice Address - Zip Code:01247-2538
Practice Address - Country:US
Practice Address - Phone:413-663-6769
Practice Address - Fax:413-663-6421
Is Sole Proprietor?:No
Enumeration Date:2016-05-11
Last Update Date:2022-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPA5735363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant