Provider Demographics
NPI:1326756974
Name:BUOY, KASEN RAY
Entity Type:Individual
Prefix:MR
First Name:KASEN
Middle Name:RAY
Last Name:BUOY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1909 HERITAGE FIELDS DRIVE
Mailing Address - Street 2:
Mailing Address - City:WASHINTON
Mailing Address - State:UT
Mailing Address - Zip Code:84780-4101
Mailing Address - Country:US
Mailing Address - Phone:435-233-8756
Mailing Address - Fax:
Practice Address - Street 1:1380 E MEDICAL CENTER DR
Practice Address - Street 2:
Practice Address - City:ST GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84790-2123
Practice Address - Country:US
Practice Address - Phone:435-251-1000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-14
Last Update Date:2023-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UTRN9545980163W00000X
UT8982383-8901367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse