Provider Demographics
NPI:1407510142
Name:GRAHAM, CASEY NICOLE (PA-C)
Entity Type:Individual
Prefix:
First Name:CASEY
Middle Name:NICOLE
Last Name:GRAHAM
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 1:200 CAMPUS DRIVE
Mailing Address - Street 2:SUITE 400
Mailing Address - City:HERSHEY
Mailing Address - State:PA
Mailing Address - Zip Code:17033
Mailing Address - Country:US
Mailing Address - Phone:717-531-6822
Mailing Address - Fax:
Practice Address - Street 1:200 CAMPUS DRIVE
Practice Address - Street 2:SUITE 400
Practice Address - City:HERSHEY
Practice Address - State:PA
Practice Address - Zip Code:17033
Practice Address - Country:US
Practice Address - Phone:717-531-6822
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-28
Last Update Date:2021-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA062798363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant