1336196237 NPI number — DR. JESSICA THERESA KASTER PHD

Table of content: DR. JESSICA THERESA KASTER PHD (NPI 1336196237)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1336196237 NPI number — DR. JESSICA THERESA KASTER PHD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KASTER
Provider First Name:
JESSICA
Provider Middle Name:
THERESA
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PHD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1336196237
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/01/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6750 FRANCE AVE S
Provider Second Line Business Mailing Address:
#340
Provider Business Mailing Address City Name:
EDINA
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55435-1903
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
952-303-4372
Provider Business Mailing Address Fax Number:
952-303-4753

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6750 FRANCE AVE S
Provider Second Line Business Practice Location Address:
#340
Provider Business Practice Location Address City Name:
EDINA
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55435-1903
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
952-303-4372
Provider Business Practice Location Address Fax Number:
952-303-4753
Provider Enumeration Date:
05/27/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 103TC0700X , with the licence number:  LP4665 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 103TC0700X , with the licence number: 4665 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 556874900 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1046556 . This is a "PREFERREDONE" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 113308 . This is a "UCARE MINNESOTA" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 26738 . This is a "NORTH DAKOTA BLUE SHIELD" identifier , issued by the state of ( ND ) . This identifiers is of the category "OTHER".
  • Identifier: HP60844 . This is a "HEALTHPARTNERS" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 89G98KA . This is a "BLUE SHIELD OF MN" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".




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