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NPI Code Detail

MEDICARE: MRS. LERA SUSAN KASSEROLER GNP

MEDICARE: MRS. LERA SUSAN KASSEROLER GNP
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
1363LG0600XGerontology Nurse Practitioner532657TX
2363LP0808XPsychiatric/Mental Health Nurse PractitionerAP113576TX

General Provider Information

NPI Number : 1821032665
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. LERA SUSAN KASSEROLER GNP
Provider Business Mailing Address
First Line : 7777 E BOARDWALK
Second Line :
City : LUMBERTON
State : TX
Zip : 77657-4901
Country : US
Telephone Number : 409-719-3700
Fax Number :
Provider Business Practice Location Address
First Line : 2750 S 8TH ST
Second Line :
City : BEAUMONT
State : TX
Zip : 77701-7719
Country : US
Telephone Number : 409-839-1000
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/15/2006
Last Update Date : 03/13/2015

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