Provider Demographics
NPI:1508155169
Name:MAHLE, CASEY KENYON (CPNP-PC)
Entity Type:Individual
Prefix:
First Name:CASEY
Middle Name:KENYON
Last Name:MAHLE
Suffix:
Gender:F
Credentials:CPNP-PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1701 WESTCHESTER DR
Mailing Address - Street 2:SUITE 850
Mailing Address - City:HIGH POINT
Mailing Address - State:NC
Mailing Address - Zip Code:27262-7008
Mailing Address - Country:US
Mailing Address - Phone:336-802-2400
Mailing Address - Fax:336-802-2536
Practice Address - Street 1:114 KINDERTON BLVD
Practice Address - Street 2:
Practice Address - City:ADVANCE
Practice Address - State:NC
Practice Address - Zip Code:27006-7302
Practice Address - Country:US
Practice Address - Phone:336-998-9742
Practice Address - Fax:336-998-9410
Is Sole Proprietor?:No
Enumeration Date:2011-04-05
Last Update Date:2015-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH12286-NP363LP0200X
NC5007441363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics