Provider Demographics
NPI:1376816777
Name:CASEY, ALICIA MARIE (PA-C)
Entity type:Individual
Prefix:
First Name:ALICIA
Middle Name:MARIE
Last Name:CASEY
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1400 8TH AVE
Mailing Address - Street 2:1ST FLOOR, BLDG. C TRANSPLANT ADMINISTRATION
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76104-4110
Mailing Address - Country:US
Mailing Address - Phone:817-922-4650
Mailing Address - Fax:817-922-4655
Practice Address - Street 1:1400 8TH AVE
Practice Address - Street 2:1ST FLOOR, BLDG. C TRANSPLANT ADMINISTRATION
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-4110
Practice Address - Country:US
Practice Address - Phone:817-922-4650
Practice Address - Fax:817-922-4655
Is Sole Proprietor?:No
Enumeration Date:2012-02-15
Last Update Date:2012-07-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXPA07677363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXTXB152827Medicare PIN