Healthcare Provider Details

I. General information

NPI: 1558191353
Provider Name (Legal Business Name): KASEY ELIZABETH BESSADA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/06/2024
Last Update Date: 08/06/2024
Certification Date: 08/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 OSTRUM ST STE 501
FOUNTAIN HILL PA
18015-1153
US

IV. Provider business mailing address

701 OSTRUM ST STE 501
FOUNTAIN HILL PA
18015-1153
US

V. Phone/Fax

Practice location:
  • Phone: 484-526-3648
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberSP029765
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: