Kassidy Desroche, is a medicare enrolled "Student In An Organized Health Care Education/training Program" in Tulsa, Oklahoma. Her current practice location is
1111 W 17th St, Tulsa, Oklahoma. You can reach out to her office (for appointments etc.) via phone at
(918) 561-1145.
Kassidy Desroche is licensed to practice in * (Not Available) (license number ) and she also participates in the medicare program. She does not accept medicare assignments directly but she may accept medicare through third-party (refer to Reassignment section below) and may also prescribe medicare part D drugs. Her NPI Number is 1881368645.
Provider's Profile
| Full Name | Kassidy Desroche |
|---|
| Gender | Female |
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| Speciality | Student In An Organized Health Care Education/training Program |
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| Location | 1111 W 17th St, Tulsa, Oklahoma |
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| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
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NPI Data:
- NPI Number: 1881368645
- Provider Enumeration Date: 08/05/2021
- Last Update Date: 08/05/2021
Medicare PECOS Information:
- PECOS PAC ID: 0840633566
- Enrollment ID: I20240209002452
Medical Identifiers
Medical identifiers for Kassidy Desroche such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
|---|
| 1881368645 | NPI | - | NPPES |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
|---|
| 363A00000X | Physician Assistant | (* (Not Available)) | Secondary |
| 390200000X | Student In An Organized Health Care Education/training Program | (* (Not Available)) | Primary |
Medicare Part D Prescriber Enrollment
Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Kassidy Desroche is
enrolled with medicare and thus, if eligible, can prescribe medicare part D drugs to patients with medicare part D benefits.
Mailing Address and Practice Location
| Mailing Address | Practice Location Address |
|---|
Kassidy Desroche,
1111 W 17th St,
Tulsa, OK 74107-1886
Ph: () - | Kassidy Desroche,
1111 W 17th St,
Tulsa, OK 74107-1886
Ph: (918) 561-1145 |
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