Provider Demographics
NPI:1619463726
Name:HARRISON, CASEY JO (CNM, DNP)
Entity Type:Individual
Prefix:
First Name:CASEY
Middle Name:JO
Last Name:HARRISON
Suffix:
Gender:F
Credentials:CNM, DNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1071 CARE WAY
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22401-8431
Mailing Address - Country:US
Mailing Address - Phone:540-374-3200
Mailing Address - Fax:540-374-3201
Practice Address - Street 1:1071 CARE WAY
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22401-8431
Practice Address - Country:US
Practice Address - Phone:540-374-3200
Practice Address - Fax:540-374-3201
Is Sole Proprietor?:No
Enumeration Date:2018-07-02
Last Update Date:2020-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024176282363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology