Provider Demographics
NPI:1861482739
Name:CASEY, CATHERINE ELAINE
Entity Type:Individual
Prefix:
First Name:CATHERINE
Middle Name:ELAINE
Last Name:CASEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:643 E 3RD ST
Mailing Address - Street 2:PO BOX 9
Mailing Address - City:GENTRY
Mailing Address - State:AR
Mailing Address - Zip Code:72734-8258
Mailing Address - Country:US
Mailing Address - Phone:479-736-2213
Mailing Address - Fax:479-736-2105
Practice Address - Street 1:643 E 3RD ST
Practice Address - Street 2:
Practice Address - City:GENTRY
Practice Address - State:AR
Practice Address - Zip Code:72734-8258
Practice Address - Country:US
Practice Address - Phone:479-736-2213
Practice Address - Fax:479-736-2105
Is Sole Proprietor?:No
Enumeration Date:2005-10-24
Last Update Date:2011-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKR0079213363LF0000X
ARA01770363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKQ14854Medicare UPIN