Healthcare Provider Details

I. General information

NPI: 1912240854
Provider Name (Legal Business Name): KASEY DIANE GREGORY MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2013
Last Update Date: 06/16/2026
Certification Date: 06/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

560 QUILEUTE HEIGHTS
LA PUSH WA
98350-0189
US

IV. Provider business mailing address

PO BOX 189
LA PUSH WA
98350-0189
US

V. Phone/Fax

Practice location:
  • Phone: 360-374-9035
  • Fax: 360-374-5448
Mailing address:
  • Phone: 360-374-4318
  • Fax: 360-374-5448

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD176129
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD60967147
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: