Provider Demographics
NPI:1215160510
Name:ANDREASEN, KACEY L (PA-C)
Entity type:Individual
Prefix:MR
First Name:KACEY
Middle Name:L
Last Name:ANDREASEN
Suffix:
Gender:M
Credentials:PA-C
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Other - Credentials:
Mailing Address - Street 1:2523 SOUTH 10TH AVENUE #103
Mailing Address - Street 2:
Mailing Address - City:CALDWELL
Mailing Address - State:ID
Mailing Address - Zip Code:83605
Mailing Address - Country:US
Mailing Address - Phone:208-459-7788
Mailing Address - Fax:208-455-3277
Practice Address - Street 1:1050 SW 3RD AVE STE 1200
Practice Address - Street 2:
Practice Address - City:ONTARIO
Practice Address - State:OR
Practice Address - Zip Code:97914-4550
Practice Address - Country:US
Practice Address - Phone:541-889-3111
Practice Address - Fax:541-889-3999
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-02
Last Update Date:2016-06-23
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical