Provider Demographics
NPI:1629446497
Name:GOINS, KASEY FAY (PA-C)
Entity Type:Individual
Prefix:
First Name:KASEY
Middle Name:FAY
Last Name:GOINS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:KASEY
Other - Middle Name:
Other - Last Name:KUSHION
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4703 FOX VALLEY DR
Mailing Address - Street 2:APT 2B
Mailing Address - City:PORTAGE
Mailing Address - State:MI
Mailing Address - Zip Code:49024-8187
Mailing Address - Country:US
Mailing Address - Phone:989-225-1678
Mailing Address - Fax:
Practice Address - Street 1:5973 BEATRICE DRIVE
Practice Address - Street 2:
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49009
Practice Address - Country:US
Practice Address - Phone:269-286-7110
Practice Address - Fax:269-286-7111
Is Sole Proprietor?:No
Enumeration Date:2015-09-09
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601007511363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical