Provider Demographics
NPI:1124525266
Name:KASKY, MISTY (DO)
Entity type:Individual
Prefix:
First Name:MISTY
Middle Name:
Last Name:KASKY
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:MISTY
Other - Middle Name:
Other - Last Name:MOYLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:367 S GULPH RD
Mailing Address - Street 2:
Mailing Address - City:KING OF PRUSSIA
Mailing Address - State:PA
Mailing Address - Zip Code:19406-3121
Mailing Address - Country:US
Mailing Address - Phone:775-428-2633
Mailing Address - Fax:775-428-2630
Practice Address - Street 1:1020 NEW RIVER PKWY STE 200
Practice Address - Street 2:
Practice Address - City:FALLON
Practice Address - State:NV
Practice Address - Zip Code:89406-7801
Practice Address - Country:US
Practice Address - Phone:775-428-2633
Practice Address - Fax:775-428-2630
Is Sole Proprietor?:No
Enumeration Date:2018-04-06
Last Update Date:2021-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVDO2984207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV250015218Medicaid
NVV69912OtherPTAN