Provider Demographics
NPI:1730665464
Name:MOORE, KASEY LYNN (CST)
Entity Type:Individual
Prefix:
First Name:KASEY
Middle Name:LYNN
Last Name:MOORE
Suffix:
Gender:F
Credentials:CST
Other - Prefix:
Other - First Name:KASEY
Other - Middle Name:LYNN
Other - Last Name:VOYLES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:16840 BUCCANEER LN STE 100
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77058-2507
Mailing Address - Country:US
Mailing Address - Phone:281-333-5114
Mailing Address - Fax:832-240-4740
Practice Address - Street 1:16840 BUCCANEER LN STE 100
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77058-2507
Practice Address - Country:US
Practice Address - Phone:281-333-5114
Practice Address - Fax:832-240-4740
Is Sole Proprietor?:No
Enumeration Date:2018-07-16
Last Update Date:2018-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX179626246ZS0410X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZS0410XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Technologist