Provider Demographics
NPI:1669796199
Name:ENGELKE, KACEE K (CST/CSFA)
Entity type:Individual
Prefix:
First Name:KACEE
Middle Name:K
Last Name:ENGELKE
Suffix:
Gender:F
Credentials:CST/CSFA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5076 SHAW RD
Mailing Address - Street 2:
Mailing Address - City:TEMPLE
Mailing Address - State:TX
Mailing Address - Zip Code:76501-7233
Mailing Address - Country:US
Mailing Address - Phone:254-718-6898
Mailing Address - Fax:
Practice Address - Street 1:5076 SHAW RD
Practice Address - Street 2:
Practice Address - City:TEMPLE
Practice Address - State:TX
Practice Address - Zip Code:76501-7233
Practice Address - Country:US
Practice Address - Phone:254-718-6898
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-26
Last Update Date:2011-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant