Provider Demographics
NPI:1912608092
Name:ROTHCHILD, KASEY THEODORA (FNP-C)
Entity type:Individual
Prefix:
First Name:KASEY
Middle Name:THEODORA
Last Name:ROTHCHILD
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:KASEY
Other - Middle Name:THEODORA
Other - Last Name:KULESA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:123 N COURT ST
Mailing Address - Street 2:
Mailing Address - City:CROWN POINT
Mailing Address - State:IN
Mailing Address - Zip Code:46307-3931
Mailing Address - Country:US
Mailing Address - Phone:219-213-2320
Mailing Address - Fax:
Practice Address - Street 1:123 N COURT ST
Practice Address - Street 2:
Practice Address - City:CROWN POINT
Practice Address - State:IN
Practice Address - Zip Code:46307-3931
Practice Address - Country:US
Practice Address - Phone:219-213-2320
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-15
Last Update Date:2024-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71013702A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily