Provider Demographics
NPI:1649853490
Name:HEATH, CASEY THOMAS (KPSS)
Entity type:Individual
Prefix:
First Name:CASEY
Middle Name:THOMAS
Last Name:HEATH
Suffix:
Gender:M
Credentials:KPSS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 CHURCH AVE
Mailing Address - Street 2:
Mailing Address - City:BOWLING GREEN
Mailing Address - State:KY
Mailing Address - Zip Code:42101-1805
Mailing Address - Country:US
Mailing Address - Phone:270-599-3092
Mailing Address - Fax:
Practice Address - Street 1:640 WRIGHT AVE
Practice Address - Street 2:
Practice Address - City:BOWLING GREEN
Practice Address - State:KY
Practice Address - Zip Code:42103-1623
Practice Address - Country:US
Practice Address - Phone:270-495-4323
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-29
Last Update Date:2021-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist