Provider Demographics
NPI:1003861717
Name:FEHER, CASEY J (PA)
Entity Type:Individual
Prefix:
First Name:CASEY
Middle Name:J
Last Name:FEHER
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:CASEY
Other - Middle Name:J
Other - Last Name:STEPHENS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:7340 SHADELAND STA STE 200
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46256-3980
Mailing Address - Country:US
Mailing Address - Phone:317-806-8260
Mailing Address - Fax:317-806-8296
Practice Address - Street 1:7340 SHADELAND STA STE 200
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46256-3980
Practice Address - Country:US
Practice Address - Phone:317-806-8260
Practice Address - Fax:317-806-8296
Is Sole Proprietor?:No
Enumeration Date:2006-05-23
Last Update Date:2012-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN10000839A363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN351984674OtherCURRENT TAX ID
INQ66975Medicare UPIN
IN058940VVVMedicare ID - Type Unspecified
IN176470IIMedicare PIN