Provider Demographics
NPI:1922698109
Name:GOETTEL, CASEY MARIE
Entity Type:Individual
Prefix:
First Name:CASEY
Middle Name:MARIE
Last Name:GOETTEL
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 1:2031 ZUMBEHL RD
Mailing Address - Street 2:
Mailing Address - City:SAINT CHARLES
Mailing Address - State:MO
Mailing Address - Zip Code:63303-2723
Mailing Address - Country:US
Mailing Address - Phone:636-206-2690
Mailing Address - Fax:636-206-2691
Practice Address - Street 1:2031 ZUMBEHL RD
Practice Address - Street 2:
Practice Address - City:SAINT CHARLES
Practice Address - State:MO
Practice Address - Zip Code:63303-2723
Practice Address - Country:US
Practice Address - Phone:636-206-2690
Practice Address - Fax:636-206-2691
Is Sole Proprietor?:No
Enumeration Date:2021-01-21
Last Update Date:2022-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2020011297363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant