Provider Demographics
NPI:1649593856
Name:MORRIS, CASEY (PA-C)
Entity Type:Individual
Prefix:
First Name:CASEY
Middle Name:
Last Name:MORRIS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1025 10TH AVE NE
Mailing Address - Street 2:DULUTH DEER RIVER
Mailing Address - City:DEER RIVER
Mailing Address - State:MN
Mailing Address - Zip Code:56636-8703
Mailing Address - Country:US
Mailing Address - Phone:218-246-8275
Mailing Address - Fax:
Practice Address - Street 1:1025 10TH AVE NE
Practice Address - Street 2:DULUTH DEER RIVER
Practice Address - City:DEER RIVER
Practice Address - State:MN
Practice Address - Zip Code:56636-8703
Practice Address - Country:US
Practice Address - Phone:218-246-8275
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-03-03
Last Update Date:2019-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN10754363A00000X
363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant