Provider Demographics
NPI:1255097051
Name:KING, CASEY NICHOEL
Entity type:Individual
Prefix:
First Name:CASEY
Middle Name:NICHOEL
Last Name:KING
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 1:117 BLOSSOM CENTRE BLVD
Mailing Address - Street 2:
Mailing Address - City:WILLARD
Mailing Address - State:OH
Mailing Address - Zip Code:44890-9317
Mailing Address - Country:US
Mailing Address - Phone:567-224-7990
Mailing Address - Fax:
Practice Address - Street 1:117 BLOSSOM CENTRE BLVD
Practice Address - Street 2:
Practice Address - City:WILLARD
Practice Address - State:OH
Practice Address - Zip Code:44890-9317
Practice Address - Country:US
Practice Address - Phone:567-560-3586
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-16
Last Update Date:2021-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator