Provider Demographics
NPI:1144004904
Name:POWELL, CASEY FORREST (RN)
Entity type:Individual
Prefix:
First Name:CASEY
Middle Name:FORREST
Last Name:POWELL
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2425 E 80 NORTH CIR
Mailing Address - Street 2:
Mailing Address - City:ST GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84790-5468
Mailing Address - Country:US
Mailing Address - Phone:503-209-6799
Mailing Address - Fax:
Practice Address - Street 1:2425 E 80 NORTH CIR
Practice Address - Street 2:
Practice Address - City:ST GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84790-5468
Practice Address - Country:US
Practice Address - Phone:503-209-6799
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-22
Last Update Date:2023-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID73527163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse