Provider Demographics
NPI:1548711757
Name:BORDAS, KASEY (CHHP)
Entity type:Individual
Prefix:MRS
First Name:KASEY
Middle Name:
Last Name:BORDAS
Suffix:
Gender:F
Credentials:CHHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1661 RANDOR CT
Mailing Address - Street 2:
Mailing Address - City:MYRTLE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29579-3356
Mailing Address - Country:US
Mailing Address - Phone:843-267-4554
Mailing Address - Fax:
Practice Address - Street 1:1661 RANDOR CT
Practice Address - Street 2:
Practice Address - City:MYRTLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29579-3356
Practice Address - Country:US
Practice Address - Phone:843-267-4554
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-24
Last Update Date:2016-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator