Provider Demographics
NPI:1528144912
Name:CHESNEY, KATHLEEN B (PAC)
Entity type:Individual
Prefix:MRS
First Name:KATHLEEN
Middle Name:B
Last Name:CHESNEY
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:KATHLEEN
Other - Middle Name:BEVERLY
Other - Last Name:CHESNEY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PA-C
Mailing Address - Street 1:1388 COURT STREET
Mailing Address - Street 2:SUITE H
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96001-1650
Mailing Address - Country:US
Mailing Address - Phone:530-246-2207
Mailing Address - Fax:530-243-6835
Practice Address - Street 1:1388 COURT STREET
Practice Address - Street 2:SUITE H
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96001-1650
Practice Address - Country:US
Practice Address - Phone:530-246-2207
Practice Address - Fax:530-243-6835
Is Sole Proprietor?:No
Enumeration Date:2006-10-27
Last Update Date:2015-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA21982363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant