1134615446 NPI number — SAMANTHA HALEY BURTON CASKEY

Table of content: SAMANTHA HALEY BURTON CASKEY (NPI 1134615446)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1134615446 NPI number — SAMANTHA HALEY BURTON CASKEY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CASKEY
Provider First Name:
SAMANTHA
Provider Middle Name:
HALEY BURTON
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BURTON
Provider Other First Name:
SAMANTHA
Provider Other Middle Name:
HAYLEY
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1134615446
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/15/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1003 7TH AVE
Provider Second Line Business Mailing Address:
STE A
Provider Business Mailing Address City Name:
KIRKLAND
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98033
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
425-658-3016
Provider Business Mailing Address Fax Number:
425-658-3017

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1003 7TH AVE
Provider Second Line Business Practice Location Address:
STE A
Provider Business Practice Location Address City Name:
KIRKLAND
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98033
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
425-658-3016
Provider Business Practice Location Address Fax Number:
425-658-3017
Provider Enumeration Date:
07/10/2018

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: 106S00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 106S00000X , with the licence number: CB60893736 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 2111488 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".




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