Provider Demographics
NPI:1407044803
Name:CASEY, BROOKE ANN (PA-C)
Entity Type:Individual
Prefix:
First Name:BROOKE
Middle Name:ANN
Last Name:CASEY
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1016 W FRONT ST
Mailing Address - Street 2:
Mailing Address - City:BERWICK
Mailing Address - State:PA
Mailing Address - Zip Code:18603-4525
Mailing Address - Country:US
Mailing Address - Phone:570-802-0102
Mailing Address - Fax:570-802-0104
Practice Address - Street 1:1016 W FRONT ST
Practice Address - Street 2:
Practice Address - City:BERWICK
Practice Address - State:PA
Practice Address - Zip Code:18603-4525
Practice Address - Country:US
Practice Address - Phone:570-802-0102
Practice Address - Fax:570-802-0104
Is Sole Proprietor?:No
Enumeration Date:2007-10-10
Last Update Date:2024-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA053188363AM0700X
PAOA006611363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA120044Medicare PIN