# KACY YEVONNE HEAD

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** No

## Provider details

- **NPI number:** 1003057951
- **Gender:** F
- **Credential:** PA

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 363A00000X | Physician Assistant | 10001167A | IN | Yes |
| 363A00000X | Physician Assistant | PA06217 | TX | — |
| 390200000X | Student in an Organized Health Care Education/Training Program | — | — | — |

## Other

- **Enumeration date:** 03/23/2009
- **Last updated:** 05/03/2012

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 000000736707 | ANTHEM PIN | IN |
| 01 | — | 1487680518 | GROUP NPI | IN |
| 05 | — | 202786401 | — | TX |
| 01 | — | 800N55 | BCBS | TX |