Provider Demographics
NPI:1053854117
Name:GAMEZ, KASEY (NP)
Entity Type:Individual
Prefix:
First Name:KASEY
Middle Name:
Last Name:GAMEZ
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:KASEY
Other - Middle Name:
Other - Last Name:GLASPIE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:400 HINCKLEY BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MI
Mailing Address - Zip Code:49203-6152
Mailing Address - Country:US
Mailing Address - Phone:517-205-8991
Mailing Address - Fax:517-205-0114
Practice Address - Street 1:400 HINCKLEY BLVD STE 100
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MI
Practice Address - Zip Code:49203-6152
Practice Address - Country:US
Practice Address - Phone:517-205-8991
Practice Address - Fax:517-205-0114
Is Sole Proprietor?:No
Enumeration Date:2016-11-22
Last Update Date:2016-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704287592363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner