Provider Demographics
NPI:1891184610
Name:ATNIP, KASEY (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:KASEY
Middle Name:
Last Name:ATNIP
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MISS
Other - First Name:KASEY
Other - Middle Name:
Other - Last Name:KREJCI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:201 LILAC ST
Mailing Address - Street 2:
Mailing Address - City:LAKE JACKSON
Mailing Address - State:TX
Mailing Address - Zip Code:77566-5470
Mailing Address - Country:US
Mailing Address - Phone:979-235-7983
Mailing Address - Fax:
Practice Address - Street 1:54 FLAG LAKE PLZ
Practice Address - Street 2:
Practice Address - City:LAKE JACKSON
Practice Address - State:TX
Practice Address - Zip Code:77566-6263
Practice Address - Country:US
Practice Address - Phone:979-297-0362
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-01-16
Last Update Date:2015-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA09479363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant