Provider Demographics
NPI:1043628746
Name:O'SHIELDS, KASEY (MMSC, PA-C, ATC)
Entity type:Individual
Prefix:
First Name:KASEY
Middle Name:
Last Name:O'SHIELDS
Suffix:
Gender:
Credentials:MMSC, PA-C, ATC
Other - Prefix:
Other - First Name:KASEY
Other - Middle Name:
Other - Last Name:RICHARDSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:125 DOUGHTY ST STE 280
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29403-5727
Mailing Address - Country:US
Mailing Address - Phone:301-801-6436
Mailing Address - Fax:
Practice Address - Street 1:125 DOUGHTY ST STE 280
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29403-5727
Practice Address - Country:US
Practice Address - Phone:301-801-6436
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-25
Last Update Date:2025-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
SC5757363AS0400X
MDA006352255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer