Provider Demographics
NPI:1487098869
Name:KASELL, ELSA AGUILAR (PA)
Entity type:Individual
Prefix:
First Name:ELSA
Middle Name:AGUILAR
Last Name:KASELL
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15806 BROOKWAY DR STE 400
Mailing Address - Street 2:
Mailing Address - City:HUNTERSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28078-3247
Mailing Address - Country:US
Mailing Address - Phone:423-741-2813
Mailing Address - Fax:
Practice Address - Street 1:15806 BROOKWAY DR
Practice Address - Street 2:SUITE 400
Practice Address - City:HUNTERSVILLE
Practice Address - State:NC
Practice Address - Zip Code:28078-3237
Practice Address - Country:US
Practice Address - Phone:704-766-1000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-04-29
Last Update Date:2020-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC001004208363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical