Provider Demographics
NPI:1356112262
Name:VACCARO, KADRA BEVERLY (PA-C)
Entity type:Individual
Prefix:
First Name:KADRA
Middle Name:BEVERLY
Last Name:VACCARO
Suffix:
Gender:
Credentials:PA-C
Other - Prefix:
Other - First Name:KADRA
Other - Middle Name:BEVERLY
Other - Last Name:RADEMACHER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7248 S LAND PARK DR STE 205
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95831-3661
Mailing Address - Country:US
Mailing Address - Phone:916-392-4000
Mailing Address - Fax:
Practice Address - Street 1:7248 S LAND PARK DR STE 205
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95831-3661
Practice Address - Country:US
Practice Address - Phone:916-392-4000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-10
Last Update Date:2025-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA63905363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant