Provider Demographics
NPI:1568686186
Name:CASTEEL, MARY K (FNP-BC)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:K
Last Name:CASTEEL
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 S MOUNT AUBURN RD
Mailing Address - Street 2:SUITE 432
Mailing Address - City:CAPE GIRARDEAU
Mailing Address - State:MO
Mailing Address - Zip Code:63703-4911
Mailing Address - Country:US
Mailing Address - Phone:573-334-7173
Mailing Address - Fax:573-334-7185
Practice Address - Street 1:150 S MOUNT AUBURN RD
Practice Address - Street 2:SUITE 432
Practice Address - City:CAPE GIRARDEAU
Practice Address - State:MO
Practice Address - Zip Code:63703-4911
Practice Address - Country:US
Practice Address - Phone:573-334-7173
Practice Address - Fax:573-334-7185
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-13
Last Update Date:2011-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO070298363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO827030653Medicare PIN
MOP00277276Medicare PIN
MOQ50745Medicare UPIN