Provider Demographics
NPI:1831646512
Name:ANDERSON, CASEY L (FNP)
Entity Type:Individual
Prefix:
First Name:CASEY
Middle Name:L
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:CASEY
Other - Middle Name:L
Other - Last Name:CARNES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:727 E COURT ST
Mailing Address - Street 2:
Mailing Address - City:PARIS
Mailing Address - State:IL
Mailing Address - Zip Code:61944-2460
Mailing Address - Country:US
Mailing Address - Phone:217-465-8411
Mailing Address - Fax:217-463-3184
Practice Address - Street 1:5 S WALNUT ST
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:IL
Practice Address - Zip Code:61943-7153
Practice Address - Country:US
Practice Address - Phone:217-346-2353
Practice Address - Fax:217-346-2355
Is Sole Proprietor?:No
Enumeration Date:2016-09-09
Last Update Date:2024-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209014589363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily