Healthcare Provider Details

I. General information

NPI: 1396649711
Provider Name (Legal Business Name): JESSICA KAGARISE RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/07/2026
Last Update Date: 10/07/2026
Certification Date: 10/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1101 EDGAR ST STE A
YORK PA
17403-2862
US

IV. Provider business mailing address

6421 HARMONY GROVE RD APT H
DOVER PA
17315-2973
US

V. Phone/Fax

Practice location:
  • Phone: 717-851-1500
  • Fax: 717-851-1515
Mailing address:
  • Phone: 717-586-8874
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN680314
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: