Provider Demographics
NPI:1154754471
Name:KASITZ, JESSE PHILIP (APRN)
Entity type:Individual
Prefix:MR
First Name:JESSE
Middle Name:PHILIP
Last Name:KASITZ
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 E CHEVES ST STE 260
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:SC
Mailing Address - Zip Code:29506-2652
Mailing Address - Country:US
Mailing Address - Phone:843-665-7941
Mailing Address - Fax:843-665-1257
Practice Address - Street 1:800 E CHEVES ST STE 260
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:SC
Practice Address - Zip Code:29506-2652
Practice Address - Country:US
Practice Address - Phone:843-665-7941
Practice Address - Fax:843-665-1257
Is Sole Proprietor?:No
Enumeration Date:2013-08-11
Last Update Date:2020-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP013051363LP2300X
SC20691363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCNP6221Medicaid