1023289717 NPI number — MS. KASEY LIN BRANDT APRN

Table of content: MS. KASEY LIN BRANDT APRN (NPI 1023289717)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1023289717 NPI number — MS. KASEY LIN BRANDT APRN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BRANDT
Provider First Name:
KASEY
Provider Middle Name:
LIN
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
APRN
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
GRIEGO
Provider Other First Name:
KASEY
Provider Other Middle Name:
LIN
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
APRN
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1023289717
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/16/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1721 RIO RANCHO BLVD NW
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
RIO RANCHO
Provider Business Mailing Address State Name:
NM
Provider Business Mailing Address Postal Code:
87124
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
505-896-8600
Provider Business Mailing Address Fax Number:
505-896-8687

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
16939 SW 134TH AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ARCHER
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32618-5413
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
352-265-2550
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/20/2008

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LP0200X , with the licence number:  CS00216645 , registered in the state of NM ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LP0200X , with the licence number: CNP-01753 , registered in the state of NM ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LP0200X , with the licence number: ARNP9230919 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LP0808X , with the licence number: APRN9230919 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)