Provider Demographics
NPI:1942588678
Name:MILLER, CASEY LYNN (CRNA)
Entity Type:Individual
Prefix:
First Name:CASEY
Middle Name:LYNN
Last Name:MILLER
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:CASEY
Other - Middle Name:LYNN
Other - Last Name:MALONEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:44 SPRING TRAIL CT
Mailing Address - Street 2:
Mailing Address - City:SAINT CHARLES
Mailing Address - State:MO
Mailing Address - Zip Code:63303-6488
Mailing Address - Country:US
Mailing Address - Phone:573-280-9998
Mailing Address - Fax:618-208-7384
Practice Address - Street 1:2 CLAYTON COURT DR
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63131-2524
Practice Address - Country:US
Practice Address - Phone:314-495-6037
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-07-29
Last Update Date:2023-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2011022107367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
MONPIOther1245427335