Provider Demographics
NPI:1508900895
Name:KESSLER, SUSAN (ARNP)
Entity Type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:
Last Name:KESSLER
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:SUSAN
Other - Middle Name:ELIZABETH
Other - Last Name:WHITCOMB
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ARNP
Mailing Address - Street 1:235 CARMEL DR
Mailing Address - Street 2:
Mailing Address - City:FORT WALTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32547-1957
Mailing Address - Country:US
Mailing Address - Phone:850-862-3141
Mailing Address - Fax:850-862-7732
Practice Address - Street 1:235 CARMEL DR
Practice Address - Street 2:
Practice Address - City:FORT WALTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:32547-1957
Practice Address - Country:US
Practice Address - Phone:850-862-3141
Practice Address - Fax:850-862-7732
Is Sole Proprietor?:No
Enumeration Date:2007-02-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP2204242363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLE2317Medicare ID - Type Unspecified