Provider Demographics
NPI:1811997950
Name:CRESSY, KATEY LYNN (PAC)
Entity type:Individual
Prefix:
First Name:KATEY
Middle Name:LYNN
Last Name:CRESSY
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9815 MAIN STREET
Mailing Address - Street 2:SUITE 208
Mailing Address - City:DAMASCUS
Mailing Address - State:MD
Mailing Address - Zip Code:20872-2002
Mailing Address - Country:US
Mailing Address - Phone:301-253-4004
Mailing Address - Fax:301-253-3391
Practice Address - Street 1:9815 MAIN STREET
Practice Address - Street 2:SUITE 208
Practice Address - City:DAMASCUS
Practice Address - State:MD
Practice Address - Zip Code:20872-2002
Practice Address - Country:US
Practice Address - Phone:301-253-4004
Practice Address - Fax:301-253-3391
Is Sole Proprietor?:No
Enumeration Date:2005-07-29
Last Update Date:2015-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDC0002356363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDC0002356OtherSTATE LICENSE
MDG02408D02Medicare PIN
MDC0002356OtherSTATE LICENSE