Provider Demographics
NPI:1891461190
Name:CASEY, LAUREN M (APRN)
Entity Type:Individual
Prefix:MRS
First Name:LAUREN
Middle Name:M
Last Name:CASEY
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 369
Mailing Address - Street 2:104 MOHAWK ST
Mailing Address - City:BROWNSVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42210
Mailing Address - Country:US
Mailing Address - Phone:270-597-2155
Mailing Address - Fax:
Practice Address - Street 1:GLK ENTERPRISES LLC DBA WILKES CLINIC
Practice Address - Street 2:104 MOHAWK ST
Practice Address - City:BROWNSVILLE
Practice Address - State:KY
Practice Address - Zip Code:42210
Practice Address - Country:US
Practice Address - Phone:270-597-2155
Practice Address - Fax:270-597-3811
Is Sole Proprietor?:No
Enumeration Date:2021-08-18
Last Update Date:2021-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3016221363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner