MEDICARE: PROF. CATHY R. KESSENICH ARNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LA2200X	Adult Health Nurse Practitioner	1100882	FL
2	363L00000X	Nurse Practitioner	ARNP1100882	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1841271996
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PROF. CATHY R. KESSENICH ARNP

Provider Business Mailing Address
First Line	:	4759 US HIGHWAY 19
Second Line	:
City	:	NEW PORT RICHEY
State	:	FL
Zip	:	34652-4945
Country	:	US
Telephone Number	:	727-841-8772
Fax Number	:	727-848-5897

Provider Business Practice Location Address
First Line	:	3314 US HIGHWAY 19
Second Line	:
City	:	HOLIDAY
State	:	FL
Zip	:	34691-1846
Country	:	US
Telephone Number	:	727-845-0588
Fax Number	:	727-842-6678

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/07/2005
Last Update Date	:	08/24/2021

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