Provider Demographics
NPI:1669036547
Name:KING, CASARA J
Entity Type:Individual
Prefix:
First Name:CASARA
Middle Name:J
Last Name:KING
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:67 SHAWVILLE RD
Mailing Address - Street 2:
Mailing Address - City:SHELDON
Mailing Address - State:VT
Mailing Address - Zip Code:05483-8383
Mailing Address - Country:US
Mailing Address - Phone:802-933-5702
Mailing Address - Fax:
Practice Address - Street 1:270 N MAIN ST
Practice Address - Street 2:
Practice Address - City:SAINT ALBANS
Practice Address - State:VT
Practice Address - Zip Code:05478-2500
Practice Address - Country:US
Practice Address - Phone:802-370-2099
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-26
Last Update Date:2019-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT026.0092336163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse