Provider Demographics
NPI:1700508694
Name:CASEY, ALYSA ANN
Entity Type:Individual
Prefix:
First Name:ALYSA
Middle Name:ANN
Last Name:CASEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9330 LBJ FWY STE 800
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75243-4310
Mailing Address - Country:US
Mailing Address - Phone:972-792-9700
Mailing Address - Fax:469-830-9601
Practice Address - Street 1:12720 HILLCREST RD STE 625
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75230-2163
Practice Address - Country:US
Practice Address - Phone:469-830-9600
Practice Address - Fax:469-830-9601
Is Sole Proprietor?:No
Enumeration Date:2022-09-16
Last Update Date:2023-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA17347363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant