Provider Demographics
NPI:1790199628
Name:COON, CASEY LAURA (FNP)
Entity Type:Individual
Prefix:
First Name:CASEY
Middle Name:LAURA
Last Name:COON
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13 SCHOOL ST
Mailing Address - Street 2:
Mailing Address - City:SHERBURNE
Mailing Address - State:NY
Mailing Address - Zip Code:13460-9505
Mailing Address - Country:US
Mailing Address - Phone:607-674-8416
Mailing Address - Fax:
Practice Address - Street 1:13 SCHOOL ST
Practice Address - Street 2:
Practice Address - City:SHERBURNE
Practice Address - State:NY
Practice Address - Zip Code:13460-9505
Practice Address - Country:US
Practice Address - Phone:607-674-8416
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-18
Last Update Date:2014-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY33338815363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily