Provider Demographics
NPI:1245664002
Name:VERA, CASEY NICOLE (PNP-PC)
Entity type:Individual
Prefix:
First Name:CASEY
Middle Name:NICOLE
Last Name:VERA
Suffix:
Gender:F
Credentials:PNP-PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 602148
Mailing Address - Street 2:APT # 111
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-2148
Mailing Address - Country:US
Mailing Address - Phone:704-304-6400
Mailing Address - Fax:
Practice Address - Street 1:231 S SHARON AMITY RD
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28211-2803
Practice Address - Country:US
Practice Address - Phone:704-304-6400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-29
Last Update Date:2014-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC233336363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCNCF651DMedicare PIN
NCNCF651AMedicare PIN
NCNCF651CMedicare PIN
NCNCF651FMedicare PIN
NCNCF651EMedicare PIN