Provider Demographics
NPI:1750045423
Name:CASEY, ETHAN HUNTER (PA-C)
Entity Type:Individual
Prefix:
First Name:ETHAN
Middle Name:HUNTER
Last Name:CASEY
Suffix:
Gender:M
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 1:204 HARMON CIR
Mailing Address - Street 2:
Mailing Address - City:WOODRUFF
Mailing Address - State:SC
Mailing Address - Zip Code:29388-9509
Mailing Address - Country:US
Mailing Address - Phone:864-706-1693
Mailing Address - Fax:
Practice Address - Street 1:1650 SKYLYN DR
Practice Address - Street 2:
Practice Address - City:SPARTANBURG
Practice Address - State:SC
Practice Address - Zip Code:29307-1047
Practice Address - Country:US
Practice Address - Phone:864-574-0017
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-28
Last Update Date:2021-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical