Healthcare Provider Details

I. General information

NPI: 1518395938
Provider Name (Legal Business Name): CASEY DALLAS PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/22/2013
Last Update Date: 08/16/2023
Certification Date: 08/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

750 E THUNDERBIRD RD STE 1-3
PHOENIX AZ
85022-5306
US

IV. Provider business mailing address

3101 N CENTRAL AVE STE 500
PHOENIX AZ
85012-2639
US

V. Phone/Fax

Practice location:
  • Phone: 602-230-7373
  • Fax: 602-218-6383
Mailing address:
  • Phone: 602-230-7373
  • Fax: 602-230-5105

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number5564
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number5564
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: