Provider Demographics
NPI:1144049073
Name:CASILLAS, KIANY (PMHNP)
Entity type:Individual
Prefix:
First Name:KIANY
Middle Name:
Last Name:CASILLAS
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1710 OAK AVE
Mailing Address - Street 2:
Mailing Address - City:DALHART
Mailing Address - State:TX
Mailing Address - Zip Code:79022-5014
Mailing Address - Country:US
Mailing Address - Phone:909-346-5134
Mailing Address - Fax:
Practice Address - Street 1:310 ROCK ISLAND AVE
Practice Address - Street 2:
Practice Address - City:DALHART
Practice Address - State:TX
Practice Address - Zip Code:79022-2651
Practice Address - Country:US
Practice Address - Phone:806-244-0136
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-08
Last Update Date:2024-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1003830363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health