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General NPI Number Information
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NPI Number | 1861847543
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Entity Type | Individual
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Provider Name | TYLER SCOTT CASAVANT PA-C, MMS
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Gender | Male
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Dates
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Enumeration Date | 04/29/2016
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Last Update Date | 04/29/2016
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Provider Practice Location Address
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Address Line | 2615 CHESTER AVE
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City | BAKERSFIELD
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State | CA
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Zip | 93301-2014
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Country | US
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Telephone | 661-395-3000
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Fax |
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Provider Business Mailing Address
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Address Line | 11318 PACIFIC SHORES DR
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City | BAKERSFIELD
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State | CA
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Zip | 93312-8212
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Country | US
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Telephone | 661-747-8614
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 53380
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License Number State | CA
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