Provider Demographics
NPI:1174087977
Name:SALGADO, CASEY KATHLEEN (PA-C)
Entity type:Individual
Prefix:MRS
First Name:CASEY
Middle Name:KATHLEEN
Last Name:SALGADO
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MISS
Other - First Name:CASEY
Other - Middle Name:KATHLEEN
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 1820
Mailing Address - Street 2:
Mailing Address - City:HAWTHORNE
Mailing Address - State:CA
Mailing Address - Zip Code:90251-1820
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1420 S MAIN ST
Practice Address - Street 2:
Practice Address - City:CULPEPER
Practice Address - State:VA
Practice Address - Zip Code:22701-3431
Practice Address - Country:US
Practice Address - Phone:540-825-2202
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-25
Last Update Date:2025-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA56478363A00000X
VA0110007530363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant