Provider Demographics
NPI:1538601273
Name:HORRELL, KASEY (PA-C)
Entity type:Individual
Prefix:
First Name:KASEY
Middle Name:
Last Name:HORRELL
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 1:13188 N 103RD DR
Mailing Address - Street 2:#200
Mailing Address - City:SUN CITY
Mailing Address - State:AZ
Mailing Address - Zip Code:85351-3064
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:13188 N 103RD DR
Practice Address - Street 2:#200
Practice Address - City:SUN CITY
Practice Address - State:AZ
Practice Address - Zip Code:85351-3064
Practice Address - Country:US
Practice Address - Phone:602-406-7830
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-11-11
Last Update Date:2016-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ6557363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical