Provider Demographics
NPI:1376631374
Name:GILL, KASEY (NP,)
Entity Type:Individual
Prefix:
First Name:KASEY
Middle Name:
Last Name:GILL
Suffix:
Gender:F
Credentials:NP,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 749495
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-9495
Mailing Address - Country:US
Mailing Address - Phone:239-432-8331
Mailing Address - Fax:813-321-1296
Practice Address - Street 1:605 MEDICAL CENTER DR STE B
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:LA
Practice Address - Zip Code:71301-8145
Practice Address - Country:US
Practice Address - Phone:225-767-0822
Practice Address - Fax:225-769-5424
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2023-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP04068363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA500028724OtherRAILROAD MEDICARE
LA1149713Medicaid
LA1149713Medicaid