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NPI Code Detail

MEDICARE: CASSIDY RAE KESHVANI PA-C

MEDICARE:   CASSIDY RAE KESHVANI  PA-C
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363AS0400XSurgical Physician AssistantPA11301TX

General Provider Information

NPI Number : 1255710794
Entity Type Code : Individual
Provider Name (Legal Business Name) : CASSIDY RAE KESHVANI PA-C
Provider Business Mailing Address
First Line : 5900 ALTAMESA BLVD STE 100
Second Line :
City : FORT WORTH
State : TX
Zip : 76132-5475
Country : US
Telephone Number : 817-854-9969
Fax Number : 803-604-0854
Provider Business Practice Location Address
First Line : 5900 ALTAMESA BLVD STE 100
Second Line :
City : FORT WORTH
State : TX
Zip : 76132-5473
Country : US
Telephone Number : 817-854-9969
Fax Number : 817-854-9965
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/28/2015
Last Update Date : 03/17/2026

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Directions to “ CASSIDY RAE KESHVANI PA-C” Practice Location

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