Provider Demographics
NPI:1467148494
Name:SWIONTEK, KASEY BROOK (FNP-C)
Entity Type:Individual
Prefix:
First Name:KASEY
Middle Name:BROOK
Last Name:SWIONTEK
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10840 ACOMA ST
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79934-2832
Mailing Address - Country:US
Mailing Address - Phone:206-900-3252
Mailing Address - Fax:
Practice Address - Street 1:431 TAYLOR RANCH RD
Practice Address - Street 2:
Practice Address - City:ALAMOGORDO
Practice Address - State:NM
Practice Address - Zip Code:88310-9570
Practice Address - Country:US
Practice Address - Phone:206-900-3252
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-13
Last Update Date:2024-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM75498363LF0000X
TX1138347363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily