Healthcare Provider Details

I. General information

NPI: 1982910014
Provider Name (Legal Business Name): KASIE CARIN NIX ANP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/26/2010
Last Update Date: 10/18/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1614 WOLF CIR
LAKE CHARLES LA
70605-2348
US

IV. Provider business mailing address

PO BOX 1786
LAKE CHARLES LA
70602-1786
US

V. Phone/Fax

Practice location:
  • Phone: 337-478-9653
  • Fax:
Mailing address:
  • Phone: 337-478-9653
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberAP06108
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: