Provider Demographics
NPI:1598263709
Name:FLEMING, CASEY DEVAUGHN (NP-C)
Entity Type:Individual
Prefix:
First Name:CASEY
Middle Name:DEVAUGHN
Last Name:FLEMING
Suffix:
Gender:M
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:625 S MONTGOMERY ST APT 80
Mailing Address - Street 2:
Mailing Address - City:STARKVILLE
Mailing Address - State:MS
Mailing Address - Zip Code:39759-3885
Mailing Address - Country:US
Mailing Address - Phone:662-416-1935
Mailing Address - Fax:
Practice Address - Street 1:14724 HIGHWAY 15 N
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:MS
Practice Address - Zip Code:39339-6318
Practice Address - Country:US
Practice Address - Phone:662-773-7500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-23
Last Update Date:2018-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS9024867363LF0000X
MSFLEM-3C9YDB363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily