Provider Demographics
NPI:1356589030
Name:KASSIN, KATHRYN THERESE (PA)
Entity type:Individual
Prefix:
First Name:KATHRYN
Middle Name:THERESE
Last Name:KASSIN
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:455 N SIOUX POINT RD
Mailing Address - Street 2:
Mailing Address - City:DAKOTA DUNES
Mailing Address - State:SD
Mailing Address - Zip Code:57049-5327
Mailing Address - Country:US
Mailing Address - Phone:605-217-7000
Mailing Address - Fax:605-217-7015
Practice Address - Street 1:455 N SIOUX POINT RD
Practice Address - Street 2:
Practice Address - City:DAKOTA DUNES
Practice Address - State:SD
Practice Address - Zip Code:57049-5327
Practice Address - Country:US
Practice Address - Phone:605-217-7000
Practice Address - Fax:605-217-7015
Is Sole Proprietor?:No
Enumeration Date:2009-02-03
Last Update Date:2012-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDAPPLIED FOR363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant