Provider Demographics
NPI:1699251728
Name:KASISKY, CASEY RAE (PA-C)
Entity type:Individual
Prefix:
First Name:CASEY
Middle Name:RAE
Last Name:KASISKY
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2603 HIGH MOUNTAIN RD
Mailing Address - Street 2:
Mailing Address - City:FALLS
Mailing Address - State:PA
Mailing Address - Zip Code:18615-7843
Mailing Address - Country:US
Mailing Address - Phone:570-240-2224
Mailing Address - Fax:
Practice Address - Street 1:340 MONTAGE MOUNTAIN RD
Practice Address - Street 2:
Practice Address - City:MOOSIC
Practice Address - State:PA
Practice Address - Zip Code:18507-1782
Practice Address - Country:US
Practice Address - Phone:570-346-3686
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-11
Last Update Date:2018-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA059861363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical