Healthcare Provider Details

I. General information

NPI: 1801170063
Provider Name (Legal Business Name): KASIE N POWER PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/06/2011
Last Update Date: 02/27/2020
Certification Date: 02/27/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3550 W FOX RIDGE LN
MUNCIE IN
47304-5205
US

IV. Provider business mailing address

3550 W FOX RIDGE LN
MUNCIE IN
47304-5205
US

V. Phone/Fax

Practice location:
  • Phone: 765-717-5399
  • Fax: 765-216-6774
Mailing address:
  • Phone: 765-717-5399
  • Fax: 765-216-6774

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number10001324A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number10001324A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: