Individual
KASEY LEE BRUNDIDGE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
1618
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200161130A
—
OK
05
—
200471490A
—
OK
01
—
292736
MEDICARE GROUP
OK
Enumeration date
06/12/2007
Last updated
10/25/2013
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