Provider Demographics
NPI:1851780506
Name:BYRD, CASY WILLAIM (NRP, CCP)
Entity Type:Individual
Prefix:
First Name:CASY
Middle Name:WILLAIM
Last Name:BYRD
Suffix:
Gender:M
Credentials:NRP, CCP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3415 N ROCHELLE LN
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61604-1076
Mailing Address - Country:US
Mailing Address - Phone:309-494-6200
Mailing Address - Fax:
Practice Address - Street 1:3415 N ROCHELLE LN
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61604-1076
Practice Address - Country:US
Practice Address - Phone:309-494-6200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-01-20
Last Update Date:2015-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL060083516146L00000X
IAPM-99-509-85146L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes146L00000XEmergency Medical Service ProvidersEmergency Medical Technician, Paramedic