Provider Demographics
NPI:1669839916
Name:CLARKE, CASEY ALLEN (PA-C)
Entity Type:Individual
Prefix:MR
First Name:CASEY
Middle Name:ALLEN
Last Name:CLARKE
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:3609 SW DURHAM DR
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27707-6507
Mailing Address - Country:US
Mailing Address - Phone:919-471-9622
Mailing Address - Fax:
Practice Address - Street 1:102 MASON FARM RD FL 3
Practice Address - Street 2:
Practice Address - City:CHAPEL HILL
Practice Address - State:NC
Practice Address - Zip Code:27514-4617
Practice Address - Country:US
Practice Address - Phone:984-974-8875
Practice Address - Fax:984-974-6741
Is Sole Proprietor?:No
Enumeration Date:2016-01-18
Last Update Date:2024-03-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC0010-06130207XS0114X, 363A00000X
363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No207XS0114XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryAdult Reconstructive Orthopaedic Surgery
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0010-06130OtherNORTH CAROLINA MEDICAL BOARD