Provider Demographics
NPI:1417206491
Name:SCOTT, CASEY J (APRN)
Entity Type:Individual
Prefix:
First Name:CASEY
Middle Name:J
Last Name:SCOTT
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:CASEY
Other - Middle Name:
Other - Last Name:CALLAHAN-SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN, PMHNP-BC
Mailing Address - Street 1:3895 WILKERSHAM WAY
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28306-8905
Mailing Address - Country:US
Mailing Address - Phone:910-973-3407
Mailing Address - Fax:
Practice Address - Street 1:4001 CUMBERLAND RD
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28306-6703
Practice Address - Country:US
Practice Address - Phone:910-973-3407
Practice Address - Fax:910-491-0077
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-05
Last Update Date:2020-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5006507363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY3007634OtherAPRN
NC5006507OtherAPRN
KY3007634OtherAPRN