Provider Demographics
NPI:1558495424
Name:CASTLEBERRY, WILLIAM B (ARNP)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:B
Last Name:CASTLEBERRY
Suffix:
Gender:M
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1411 E MCANDREWS RD
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97504-6107
Mailing Address - Country:US
Mailing Address - Phone:541-773-1435
Mailing Address - Fax:541-858-6828
Practice Address - Street 1:1411 E MCANDREWS RD
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97504-6107
Practice Address - Country:US
Practice Address - Phone:541-773-1435
Practice Address - Fax:541-858-6828
Is Sole Proprietor?:No
Enumeration Date:2007-03-15
Last Update Date:2022-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMCNP-02428363L00000X
WAAP60084651363L00000X, 364SC0200X
OR201708669NP-PP363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No364SC0200XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA025904OtherL&I KRMC GROUP NUMBER
WA1558495424Medicaid
NM31436374Medicaid
WA1558495424Medicaid