Provider Demographics
NPI:1790333136
Name:MAGIS-AGOSTA, CASEY RYAN (CPNP-PC, APRN, MSN)
Entity Type:Individual
Prefix:
First Name:CASEY
Middle Name:RYAN
Last Name:MAGIS-AGOSTA
Suffix:
Gender:M
Credentials:CPNP-PC, APRN, MSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15278 EVANS VALLEY RD NE
Mailing Address - Street 2:
Mailing Address - City:SILVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97381-9295
Mailing Address - Country:US
Mailing Address - Phone:503-880-6216
Mailing Address - Fax:
Practice Address - Street 1:8332 SE 13TH AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97202-7102
Practice Address - Country:US
Practice Address - Phone:503-595-9300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-28
Last Update Date:2019-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR201907043NP-PP363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics