Provider Demographics
NPI:1003196684
Name:BRIM, CASIE NICOLE (NP)
Entity Type:Individual
Prefix:
First Name:CASIE
Middle Name:NICOLE
Last Name:BRIM
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:CASIE
Other - Middle Name:NICOLE
Other - Last Name:BENTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1919 S WHEELING AVE
Mailing Address - Street 2:STE 606
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74104-5635
Mailing Address - Country:US
Mailing Address - Phone:918-748-7676
Mailing Address - Fax:
Practice Address - Street 1:1919 S WHEELING AVE
Practice Address - Street 2:SUITE 606
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74104-5638
Practice Address - Country:US
Practice Address - Phone:918-748-7676
Practice Address - Fax:918-293-3130
Is Sole Proprietor?:No
Enumeration Date:2011-08-26
Last Update Date:2016-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK80718363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner