Provider Demographics
NPI:1609239938
Name:PETERSON, CASEY CRUMP (NP-C)
Entity Type:Individual
Prefix:MRS
First Name:CASEY
Middle Name:CRUMP
Last Name:PETERSON
Suffix:
Gender:F
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:PROSPERO HEALTH PARTNERS PC
Mailing Address - Street 2:PROMENADE II 1230 PEACHTREE ST. NE 19TH FLOOR
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30309-3574
Mailing Address - Country:US
Mailing Address - Phone:866-949-0108
Mailing Address - Fax:
Practice Address - Street 1:40 S MAIN ST STE 1300
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38103-5513
Practice Address - Country:US
Practice Address - Phone:866-949-0108
Practice Address - Fax:866-620-4792
Is Sole Proprietor?:No
Enumeration Date:2016-04-04
Last Update Date:2021-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN214257363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily