Kethline Jean Dacisse

Primary specialty

Gerontology Registered NurseTaxonomy code 163WG0600X

License

481694 Issued in NY

Practice address

800 Front St
Hempstead, NY 11550-4600

Phone

(516) 705-9700

NPI assigned

Mar 24, 2021

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1616544000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1616544000000",
    "number": "1225615685",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11 WHALEY ST",
            "city": "FREEPORT",
            "state": "NY",
            "postal_code": "115204920",
            "telephone_number": "516-643-7752"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "800 FRONT ST",
            "city": "HEMPSTEAD",
            "state": "NY",
            "postal_code": "115504600",
            "telephone_number": "516-705-9700"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DACISSE",
        "first_name": "KETHLINE",
        "middle_name": "JEAN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-03-24",
        "last_updated": "2021-03-24",
        "certification_date": "2021-03-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163WG0600X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Gerontology",
            "state": "NY",
            "license": "481694",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Gerontology Registered Nurse in Hempstead, NY
• Providers in Hempstead, NY by specialty
• Gerontology Registered Nurse in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 24, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.