Provider Demographics
NPI:1194969105
Name:BANTES-BEHMKE, KASEY LYNN (PA-C)
Entity type:Individual
Prefix:MRS
First Name:KASEY
Middle Name:LYNN
Last Name:BANTES-BEHMKE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MS
Other - First Name:KASEY
Other - Middle Name:LYNN
Other - Last Name:BANTES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:2502 S. ASHLAND AVE.
Mailing Address - Street 2:
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54304
Mailing Address - Country:US
Mailing Address - Phone:920-496-4700
Mailing Address - Fax:
Practice Address - Street 1:2502 S. ASHLAND AVE.
Practice Address - Street 2:
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54304
Practice Address - Country:US
Practice Address - Phone:920-496-4700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-04-22
Last Update Date:2023-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2415-023363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI100003667Medicaid