Healthcare Provider Details

I. General information

NPI: 1124525266
Provider Name (Legal Business Name): MISTY KASKY DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MISTY MOYLE

II. Dates (important events)

Enumeration Date: 04/06/2018
Last Update Date: 11/29/2021
Certification Date: 11/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1020 NEW RIVER PKWY STE 200
FALLON NV
89406-7801
US

IV. Provider business mailing address

367 S GULPH RD
KING OF PRUSSIA PA
19406-3121
US

V. Phone/Fax

Practice location:
  • Phone: 775-428-2633
  • Fax: 775-428-2630
Mailing address:
  • Phone: 775-428-2633
  • Fax: 775-428-2630

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberDO2984
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: