Provider Demographics
NPI:1609113554
Name:CLEVENGER, CASEY RENEE (CNP)
Entity Type:Individual
Prefix:MRS
First Name:CASEY
Middle Name:RENEE
Last Name:CLEVENGER
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:272 HOSPITAL RD STE 6
Mailing Address - Street 2:
Mailing Address - City:CHILLICOTHE
Mailing Address - State:OH
Mailing Address - Zip Code:45601-9031
Mailing Address - Country:US
Mailing Address - Phone:740-779-4275
Mailing Address - Fax:740-779-4257
Practice Address - Street 1:4437 STATE ROUTE 159
Practice Address - Street 2:SUITE 125
Practice Address - City:CHILLICOTHE
Practice Address - State:OH
Practice Address - Zip Code:45601-7065
Practice Address - Country:US
Practice Address - Phone:740-779-4570
Practice Address - Fax:740-779-4579
Is Sole Proprietor?:No
Enumeration Date:2013-01-12
Last Update Date:2020-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCOA.14264-NP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0079125Medicaid