Provider Demographics
NPI:1871964676
Name:PALMER, KASIE (PA-C)
Entity type:Individual
Prefix:
First Name:KASIE
Middle Name:
Last Name:PALMER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 35914
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89133-5914
Mailing Address - Country:US
Mailing Address - Phone:702-485-5300
Mailing Address - Fax:702-750-1804
Practice Address - Street 1:2615 BOX CANYON DR
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89128-0450
Practice Address - Country:US
Practice Address - Phone:702-998-9001
Practice Address - Fax:702-998-8282
Is Sole Proprietor?:No
Enumeration Date:2015-10-19
Last Update Date:2023-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV6263363AM0700X
NVPA1676363AM0700X
CA60969363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical