Provider Demographics
NPI:1508223215
Name:CORTEZ, CASEY
Entity Type:Individual
Prefix:
First Name:CASEY
Middle Name:
Last Name:CORTEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 S MONROE ST STE 5
Mailing Address - Street 2:
Mailing Address - City:ELK CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73644-5761
Mailing Address - Country:US
Mailing Address - Phone:580-339-2623
Mailing Address - Fax:
Practice Address - Street 1:100 S MONROE ST STE 5
Practice Address - Street 2:
Practice Address - City:ELK CITY
Practice Address - State:OK
Practice Address - Zip Code:73644-5761
Practice Address - Country:US
Practice Address - Phone:580-339-2623
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-26
Last Update Date:2016-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator