Healthcare Provider Details

I. General information

NPI: 1861022469
Provider Name (Legal Business Name): CASEY GILES PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/22/2020
Last Update Date: 10/29/2024
Certification Date: 10/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1707 W CHARLESTON BLVD STE 190
LAS VEGAS NV
89102-2352
US

IV. Provider business mailing address

3016 W CHARLESTON BLVD STE 100
LAS VEGAS NV
89102-1973
US

V. Phone/Fax

Practice location:
  • Phone: 702-671-5110
  • Fax: 702-384-6592
Mailing address:
  • Phone: 702-780-7118
  • Fax: 702-895-4014

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA2248
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: