Provider Demographics
NPI:1164855631
Name:SLUSHER, CASEY ANNE (PA-C)
Entity Type:Individual
Prefix:
First Name:CASEY
Middle Name:ANNE
Last Name:SLUSHER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:CASEY
Other - Middle Name:ANNE
Other - Last Name:VASTA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:3708 JEFFERSON ST
Mailing Address - Street 2:STE A
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78731-6206
Mailing Address - Country:US
Mailing Address - Phone:512-459-6503
Mailing Address - Fax:512-454-7453
Practice Address - Street 1:3708 JEFFERSON ST
Practice Address - Street 2:STE A
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78731-6206
Practice Address - Country:US
Practice Address - Phone:512-459-6503
Practice Address - Fax:512-454-7453
Is Sole Proprietor?:No
Enumeration Date:2013-08-19
Last Update Date:2016-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA08619363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
522947YMVUOtherWNI