Provider Demographics
NPI:1528378122
Name:CIRINO, CASEY JO (FNP)
Entity Type:Individual
Prefix:
First Name:CASEY
Middle Name:JO
Last Name:CIRINO
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2108 CLAYTON PL
Mailing Address - Street 2:
Mailing Address - City:HATTIESBURG
Mailing Address - State:MS
Mailing Address - Zip Code:39402-2805
Mailing Address - Country:US
Mailing Address - Phone:601-602-2014
Mailing Address - Fax:601-602-2015
Practice Address - Street 1:902 KIRKWOOD AVE NW
Practice Address - Street 2:
Practice Address - City:LENOIR
Practice Address - State:NC
Practice Address - Zip Code:28645-5121
Practice Address - Country:US
Practice Address - Phone:828-754-0101
Practice Address - Fax:828-757-0402
Is Sole Proprietor?:No
Enumeration Date:2010-10-15
Last Update Date:2023-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5017706363L00000X, 363LF0000X
MSR876991363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS09016203Medicaid
C02674OtherMEDICARE GROUP