Provider Demographics
NPI:1336965235
Name:DAVIS, KASEY RAE (PA-S)
Entity type:Individual
Prefix:
First Name:KASEY
Middle Name:RAE
Last Name:DAVIS
Suffix:
Gender:F
Credentials:PA-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3333 OAKWELL CT APT 633
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78218-3046
Mailing Address - Country:US
Mailing Address - Phone:575-318-4914
Mailing Address - Fax:
Practice Address - Street 1:3333 OAKWELL CT APT 633
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78218-3046
Practice Address - Country:US
Practice Address - Phone:575-318-4914
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-25
Last Update Date:2024-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program