Provider Demographics
NPI:1023472446
Name:WOOLSEY, CASEY J (CNP)
Entity type:Individual
Prefix:
First Name:CASEY
Middle Name:J
Last Name:WOOLSEY
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:CASEY
Other - Middle Name:J
Other - Last Name:WALLACE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 579
Mailing Address - Street 2:
Mailing Address - City:DURANT
Mailing Address - State:OK
Mailing Address - Zip Code:74702-0579
Mailing Address - Country:US
Mailing Address - Phone:580-920-2122
Mailing Address - Fax:580-920-9976
Practice Address - Street 1:206 N 16TH ST
Practice Address - Street 2:
Practice Address - City:HUGO
Practice Address - State:OK
Practice Address - Zip Code:74743-4205
Practice Address - Country:US
Practice Address - Phone:580-920-2122
Practice Address - Fax:580-920-9976
Is Sole Proprietor?:No
Enumeration Date:2016-04-12
Last Update Date:2016-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK85721363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily