Provider Demographics
NPI:1063683241
Name:SEBERT, KACEY (PA)
Entity Type:Individual
Prefix:
First Name:KACEY
Middle Name:
Last Name:SEBERT
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:160 WARRIOR DR
Mailing Address - Street 2:
Mailing Address - City:STEPHENS CITY
Mailing Address - State:VA
Mailing Address - Zip Code:22655-4044
Mailing Address - Country:US
Mailing Address - Phone:540-868-4100
Mailing Address - Fax:540-868-0888
Practice Address - Street 1:160 WARRIOR DR
Practice Address - Street 2:
Practice Address - City:STEPHENS CITY
Practice Address - State:VA
Practice Address - Zip Code:22655-4044
Practice Address - Country:US
Practice Address - Phone:540-868-4100
Practice Address - Fax:540-868-0888
Is Sole Proprietor?:No
Enumeration Date:2008-03-17
Last Update Date:2013-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0110002742OtherLICENSE
VA0110002742OtherLICENSE