Provider Demographics
NPI:1083113047
Name:BARTHELEMY, KASSANDRA (NP)
Entity type:Individual
Prefix:
First Name:KASSANDRA
Middle Name:
Last Name:BARTHELEMY
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5017 PEPPER LN
Mailing Address - Street 2:
Mailing Address - City:DOUGLASSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:19518-9505
Mailing Address - Country:US
Mailing Address - Phone:267-431-5305
Mailing Address - Fax:
Practice Address - Street 1:2211 QUARRY DR STE E58C
Practice Address - Street 2:
Practice Address - City:WEST LAWN
Practice Address - State:PA
Practice Address - Zip Code:19609-1170
Practice Address - Country:US
Practice Address - Phone:484-773-1141
Practice Address - Fax:484-214-7768
Is Sole Proprietor?:No
Enumeration Date:2018-02-06
Last Update Date:2025-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP018713363L00000X
PAAG01180040364SG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SG0600XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistGerontology
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner