Provider Demographics
NPI:1114549979
Name:DOOLEY, CASEY (PA-C)
Entity Type:Individual
Prefix:
First Name:CASEY
Middle Name:
Last Name:DOOLEY
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:209 E 5TH ST
Mailing Address - Street 2:
Mailing Address - City:BOWEN
Mailing Address - State:IL
Mailing Address - Zip Code:62316-1130
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:209 E 5TH ST
Practice Address - Street 2:
Practice Address - City:BOWEN
Practice Address - State:IL
Practice Address - Zip Code:62316-1130
Practice Address - Country:US
Practice Address - Phone:217-842-5211
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-14
Last Update Date:2023-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL085.008539363A00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL085008539OtherPHYSICIAN ASSISTANT