Provider Demographics
NPI:1285228700
Name:CASEY, DESIREE NICHOLE (PA)
Entity Type:Individual
Prefix:
First Name:DESIREE
Middle Name:NICHOLE
Last Name:CASEY
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:DESIRE
Other - Middle Name:NICHOLE
Other - Last Name:CASEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:205 MARKLAND RD
Mailing Address - Street 2:
Mailing Address - City:ADVANCE
Mailing Address - State:NC
Mailing Address - Zip Code:27006-7020
Mailing Address - Country:US
Mailing Address - Phone:336-462-4323
Mailing Address - Fax:
Practice Address - Street 1:205 MARKLAND RD
Practice Address - Street 2:
Practice Address - City:ADVANCE
Practice Address - State:NC
Practice Address - Zip Code:27006-7020
Practice Address - Country:US
Practice Address - Phone:336-462-4323
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-24
Last Update Date:2024-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant