Healthcare Provider Details

I. General information

NPI: 1154084952
Provider Name (Legal Business Name): KATE DOMINIQUE KASPERSKI PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/19/2021
Last Update Date: 11/08/2022
Certification Date: 11/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

641 UNIVERSITY BLVD STE 211
JUPITER FL
33458-2794
US

IV. Provider business mailing address

641 UNIVERSITY BLVD STE 211
JUPITER FL
33458-2794
US

V. Phone/Fax

Practice location:
  • Phone: 561-253-8121
  • Fax:
Mailing address:
  • Phone: 561-253-8121
  • Fax: 561-253-8021

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: