1891106415 NPI number — DANIELLE KASSELLA ARNP, PMHNP-BC FNP-C

Table of content: DANIELLE KASSELLA ARNP, PMHNP-BC FNP-C (NPI 1891106415)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1891106415 NPI number — DANIELLE KASSELLA ARNP, PMHNP-BC FNP-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KASSELLA
Provider First Name:
DANIELLE
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
ARNP, PMHNP-BC FNP-C
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:
1891106415
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/23/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
13780 SE 46TH ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OKEECHOBEE
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
34974-1014
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
863-634-2672
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1000 SE MONTEREY COMMONS BLVD STE 104
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
STUART
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
34996-3327
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
772-882-8900
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/16/2014

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: 363LF0000X , with the licence number:  ARNP2917662 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LP0808X , with the licence number: APRN2917662 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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