Provider Demographics
NPI:1760720049
Name:FLORES, KACEY WHITE (PA-C)
Entity Type:Individual
Prefix:
First Name:KACEY
Middle Name:WHITE
Last Name:FLORES
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:STEVEN
Other - Middle Name:KACEY
Other - Last Name:WHITE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2584 STATE HIGHWAY 124
Mailing Address - Street 2:
Mailing Address - City:WINNIE
Mailing Address - State:TX
Mailing Address - Zip Code:77665-7889
Mailing Address - Country:US
Mailing Address - Phone:409-296-4444
Mailing Address - Fax:
Practice Address - Street 1:2584 STATE HIGHWAY 124
Practice Address - Street 2:
Practice Address - City:WINNIE
Practice Address - State:TX
Practice Address - Zip Code:77665-7889
Practice Address - Country:US
Practice Address - Phone:409-296-4444
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-01-22
Last Update Date:2024-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant