Provider Demographics
NPI:1053807255
Name:CASSIDY, KIRSTYN SHEA (RN)
Entity type:Individual
Prefix:
First Name:KIRSTYN
Middle Name:SHEA
Last Name:CASSIDY
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5105 WOODMONT CIR
Mailing Address - Street 2:
Mailing Address - City:MACUNGIE
Mailing Address - State:PA
Mailing Address - Zip Code:18062-8590
Mailing Address - Country:US
Mailing Address - Phone:757-660-7892
Mailing Address - Fax:
Practice Address - Street 1:5105 WOODMONT CIR
Practice Address - Street 2:
Practice Address - City:MACUNGIE
Practice Address - State:PA
Practice Address - Zip Code:18062-8590
Practice Address - Country:US
Practice Address - Phone:757-660-7892
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-11
Last Update Date:2018-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN691716163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
PARN691716OtherRN LICENSE