Provider Demographics
NPI:1124078175
Name:KASKASUTO, BILLIE J (DC, FNP-C)
Entity type:Individual
Prefix:DR
First Name:BILLIE
Middle Name:J
Last Name:KASKASUTO
Suffix:
Gender:F
Credentials:DC, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:610 W NORTH ST SUITE B
Mailing Address - Street 2:
Mailing Address - City:ENTERPRISE
Mailing Address - State:OR
Mailing Address - Zip Code:97828-1427
Mailing Address - Country:US
Mailing Address - Phone:541-426-9355
Mailing Address - Fax:541-426-6437
Practice Address - Street 1:610 W NORTH ST SUITE B
Practice Address - Street 2:
Practice Address - City:ENTERPRISE
Practice Address - State:OR
Practice Address - Zip Code:97828-1427
Practice Address - Country:US
Practice Address - Phone:541-426-9355
Practice Address - Fax:541-426-6437
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-11
Last Update Date:2016-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR3299 OR111NS0005X
OR201600042NP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No111NS0005XChiropractic ProvidersChiropractorSports Physician
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORU61156Medicare UPIN
OR111070Medicare PIN