Provider Demographics
NPI:1538538707
Name:KASSEN, JACLYN SUSAN ROERS (FNP-C)
Entity type:Individual
Prefix:MRS
First Name:JACLYN
Middle Name:SUSAN ROERS
Last Name:KASSEN
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 SW 7TH ST STE A205
Mailing Address - Street 2:
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98057-2983
Mailing Address - Country:US
Mailing Address - Phone:509-222-1275
Mailing Address - Fax:509-491-3031
Practice Address - Street 1:3345 39TH ST S STE 2
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58104
Practice Address - Country:US
Practice Address - Phone:877-522-1275
Practice Address - Fax:509-491-3031
Is Sole Proprietor?:No
Enumeration Date:2015-09-17
Last Update Date:2025-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANP95003104363LF0000X
NDR37012363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily