Provider Demographics
NPI:1548148422
Name:ROSARIO, KESSIAH SERENA
Entity type:Individual
Prefix:
First Name:KESSIAH
Middle Name:SERENA
Last Name:ROSARIO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KESSIAH
Other - Middle Name:
Other - Last Name:ROLAND
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1058 FAWNRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:NEWFOUNDLAND
Mailing Address - State:PA
Mailing Address - Zip Code:18445-7736
Mailing Address - Country:US
Mailing Address - Phone:610-390-7563
Mailing Address - Fax:
Practice Address - Street 1:2214 5TH ST STE 5
Practice Address - Street 2:
Practice Address - City:WHITE BEAR LAKE
Practice Address - State:MN
Practice Address - Zip Code:55110-3039
Practice Address - Country:US
Practice Address - Phone:833-946-4436
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-26
Last Update Date:2025-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP031319363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily