Provider Demographics
NPI:1033701370
Name:HASELEY, KASEY JASON (PA-C)
Entity Type:Individual
Prefix:
First Name:KASEY
Middle Name:JASON
Last Name:HASELEY
Suffix:
Gender:M
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 1:401 E CARRILLO ST
Mailing Address - Street 2:
Mailing Address - City:SANTA BARBARA
Mailing Address - State:CA
Mailing Address - Zip Code:93101-1460
Mailing Address - Country:US
Mailing Address - Phone:716-425-1610
Mailing Address - Fax:
Practice Address - Street 1:6745 ROSE CT
Practice Address - Street 2:
Practice Address - City:NIAGARA FALLS
Practice Address - State:NY
Practice Address - Zip Code:14304-4507
Practice Address - Country:US
Practice Address - Phone:716-425-1610
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-08
Last Update Date:2022-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant