Provider Demographics
NPI:1427141779
Name:HANCOCK, KAYCIE DAIGLE (CRNA)
Entity type:Individual
Prefix:
First Name:KAYCIE
Middle Name:DAIGLE
Last Name:HANCOCK
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:KAYCIE
Other - Middle Name:YOLAND
Other - Last Name:DAIGLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3919 PARKWOOD ST
Mailing Address - Street 2:
Mailing Address - City:NACOGDOCHES
Mailing Address - State:TX
Mailing Address - Zip Code:75965-6566
Mailing Address - Country:US
Mailing Address - Phone:936-559-1910
Mailing Address - Fax:
Practice Address - Street 1:3919 PARKWOOD ST
Practice Address - Street 2:
Practice Address - City:NACOGDOCHES
Practice Address - State:TX
Practice Address - Zip Code:75965-6566
Practice Address - Country:US
Practice Address - Phone:936-559-1910
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX072472367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered