Provider Demographics
NPI:1346005915
Name:ABERNATHY, CASEY L
Entity Type:Individual
Prefix:MR
First Name:CASEY
Middle Name:L
Last Name:ABERNATHY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3601 S 610 RD
Mailing Address - Street 2:
Mailing Address - City:QUAPAW
Mailing Address - State:OK
Mailing Address - Zip Code:74363-1754
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3501 S 610 RD
Practice Address - Street 2:
Practice Address - City:QUAPAW
Practice Address - State:OK
Practice Address - Zip Code:74363-1756
Practice Address - Country:US
Practice Address - Phone:918-541-5869
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-14
Last Update Date:2024-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide