Provider Demographics
NPI:1790543510
Name:GONZALES, CASEY KATHLEEN
Entity Type:Individual
Prefix:MRS
First Name:CASEY
Middle Name:KATHLEEN
Last Name:GONZALES
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:CASEY
Other - Middle Name:KATHLEEN
Other - Last Name:MIHALOV
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3407 FARNHAM CIR
Mailing Address - Street 2:
Mailing Address - City:PEARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:77584-9814
Mailing Address - Country:US
Mailing Address - Phone:281-907-3516
Mailing Address - Fax:
Practice Address - Street 1:3407 FARNHAM CIR
Practice Address - Street 2:
Practice Address - City:PEARLAND
Practice Address - State:TX
Practice Address - Zip Code:77584-9814
Practice Address - Country:US
Practice Address - Phone:281-907-3516
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-07
Last Update Date:2024-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1153780363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care