Provider Demographics
NPI:1275190936
Name:ADAMS, CASEY PETER (PA)
Entity Type:Individual
Prefix:
First Name:CASEY
Middle Name:PETER
Last Name:ADAMS
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 E ROSS ST
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:KS
Mailing Address - Zip Code:67026-7824
Mailing Address - Country:US
Mailing Address - Phone:620-584-2055
Mailing Address - Fax:
Practice Address - Street 1:101 E ROSS ST
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:KS
Practice Address - Zip Code:67026-7824
Practice Address - Country:US
Practice Address - Phone:620-584-2055
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-28
Last Update Date:2022-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant