Provider Demographics
NPI:1962485060
Name:SWAFFORD, KASEY (PA-C)
Entity Type:Individual
Prefix:
First Name:KASEY
Middle Name:
Last Name:SWAFFORD
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 S 8TH ST
Mailing Address - Street 2:
Mailing Address - City:GRIFFIN
Mailing Address - State:GA
Mailing Address - Zip Code:30224-4213
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2021 HERNDON AVE
Practice Address - Street 2:STE. 101
Practice Address - City:CLOVIS
Practice Address - State:CA
Practice Address - Zip Code:93611-6101
Practice Address - Country:US
Practice Address - Phone:559-797-4315
Practice Address - Fax:559-797-1651
Is Sole Proprietor?:No
Enumeration Date:2005-11-22
Last Update Date:2024-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA559416163W00000X
GA11429363A00000X
CAPA18002363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No163W00000XNursing Service ProvidersRegistered Nurse
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1068754OtherNCCPA CERT #
CA559415OtherRN LICENSE
CA559415OtherRN LICENSE
CAMS131864OtherDEA CERT
CAQ53774Medicare UPIN