Healthcare Provider Details

I. General information

NPI: 1023377397
Provider Name (Legal Business Name): KEMA KASALABA APRN, CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/08/2012
Last Update Date: 10/24/2022
Certification Date: 10/24/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1010 SW COAST HIGHWAY SUITE 201
NEWPORT OR
97365-5240
US

IV. Provider business mailing address

1010 SW COAST HIGHWAY SUITE 201
NEWPORT OR
97365-5240
US

V. Phone/Fax

Practice location:
  • Phone: 541-265-8816
  • Fax: 541-265-3890
Mailing address:
  • Phone: 541-265-8816
  • Fax: 541-265-3890

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR199800
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number9221193
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number3984
License Number StateMN
# 4
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number201405292NP-PP
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: