Individual
MR. KACEY L ANDREASEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
1050 SW 3RD AVE STE 1200, ONTARIO, OR 97914-4550
(541) 889-3111
(541) 889-3999
Mailing address
2523 SOUTH 10TH AVENUE #103, CALDWELL, ID 83605
(208) 459-7788
(208) 455-3277
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
—
—
363AS0400X
Surgical Physician Assistant
—
—
Other
Enumeration date
09/02/2009
Last updated
06/23/2016
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