Provider Demographics
NPI:1225008451
Name:BOLICK, CASEY D (CRNA)
Entity Type:Individual
Prefix:MR
First Name:CASEY
Middle Name:D
Last Name:BOLICK
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:415 N CENTER ST
Mailing Address - Street 2:STE 201
Mailing Address - City:HICKORY
Mailing Address - State:NC
Mailing Address - Zip Code:28601-5036
Mailing Address - Country:US
Mailing Address - Phone:828-327-8105
Mailing Address - Fax:828-327-4245
Practice Address - Street 1:415 N CENTER ST
Practice Address - Street 2:STE 201
Practice Address - City:HICKORY
Practice Address - State:NC
Practice Address - Zip Code:28601-5036
Practice Address - Country:US
Practice Address - Phone:828-327-8105
Practice Address - Fax:828-327-4245
Is Sole Proprietor?:No
Enumeration Date:2006-01-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC165268367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8052048Medicaid
NC8052048Medicaid