Basic Information
| Provider Information | |||||||||
| NPI: | 1407284078 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CROSBY | ||||||||
| FirstName: | KASEY | ||||||||
| MiddleName: | BRAGG | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1303 DANTIGNAC ST | ||||||||
| Address2: | SUITE 1200 | ||||||||
| City: | AUGUSTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 309012775 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7067747760 | ||||||||
| FaxNumber: | 7067747766 | ||||||||
| Practice Location | |||||||||
| Address1: | 1303 DANTIGNAC ST | ||||||||
| Address2: | SUITE 1200 | ||||||||
| City: | AUGUSTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 309012775 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7067747760 | ||||||||
| FaxNumber: | 7067747766 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/17/2013 | ||||||||
| LastUpdateDate: | 10/17/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | 6977 | GA | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
No ID Information.