Provider Demographics
NPI:1306556519
Name:STETSER, KENNETH JAMES (PA-C)
Entity type:Individual
Prefix:
First Name:KENNETH
Middle Name:JAMES
Last Name:STETSER
Suffix:
Gender:M
Credentials:PA-C
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Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:301 LIPPINCOTT DR STE 410
Mailing Address - Street 2:
Mailing Address - City:MARLTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08053-4197
Mailing Address - Country:US
Mailing Address - Phone:856-355-0340
Mailing Address - Fax:856-355-0330
Practice Address - Street 1:100 BOWMAN DR LOWR LEVEL2
Practice Address - Street 2:
Practice Address - City:VOORHEES
Practice Address - State:NJ
Practice Address - Zip Code:08043-9612
Practice Address - Country:US
Practice Address - Phone:856-247-2160
Practice Address - Fax:856-247-2165
Is Sole Proprietor?:No
Enumeration Date:2022-11-29
Last Update Date:2025-05-09
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IL085010201363A00000X
NJ25MP00772600363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant