Provider Demographics
NPI:1366454274
Name:ANGELL, CASEY LYNN (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:CASEY
Middle Name:LYNN
Last Name:ANGELL
Suffix:
Gender:F
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 1:5117 SUNMORE CIR
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:TX
Mailing Address - Zip Code:79707-5124
Mailing Address - Country:US
Mailing Address - Phone:432-689-2512
Mailing Address - Fax:432-689-2108
Practice Address - Street 1:5117 SUNMORE CIR
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:TX
Practice Address - Zip Code:79707
Practice Address - Country:US
Practice Address - Phone:432-689-2512
Practice Address - Fax:432-689-2108
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-12
Last Update Date:2019-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA04642363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXPA04642OtherPA LICENSE
TX8N9750OtherBLUE CROSS BLUE SHIELD
TX110400202Medicaid
TXPA04642OtherPA LICENSE
TX8G2119Medicare ID - Type Unspecified