Individual
MRS. CASEY LYNN ANGELL
Active
Individual
MRS. CASEY LYNN ANGELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PA-C
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
PA04642
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
110400202
—
TX
01
—
8N9750
BLUE CROSS BLUE SHIELD
TX
01
—
PA04642
PA LICENSE
TX
Enumeration date
08/12/2006
Last updated
10/31/2019
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