Provider Demographics
NPI:1851716823
Name:KASPER, KAITLYN (PAC)
Entity type:Individual
Prefix:
First Name:KAITLYN
Middle Name:
Last Name:KASPER
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:KAITLYN
Other - Middle Name:
Other - Last Name:THOMPSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PAC
Mailing Address - Street 1:2 INDUSTRIAL BLVD STE 200
Mailing Address - Street 2:
Mailing Address - City:PAOLI
Mailing Address - State:PA
Mailing Address - Zip Code:19301-1648
Mailing Address - Country:US
Mailing Address - Phone:610-647-2400
Mailing Address - Fax:610-647-7430
Practice Address - Street 1:2 INDUSTRIAL BLVD STE 200
Practice Address - Street 2:
Practice Address - City:PAOLI
Practice Address - State:PA
Practice Address - Zip Code:19301-1648
Practice Address - Country:US
Practice Address - Phone:610-647-2400
Practice Address - Fax:610-647-7430
Is Sole Proprietor?:No
Enumeration Date:2014-02-27
Last Update Date:2024-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA056746363A00000X, 363AM0700X
PAMA056745363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical