Provider Demographics
NPI:1295517019
Name:GRANGER, CASEY (DNP)
Entity type:Individual
Prefix:
First Name:CASEY
Middle Name:
Last Name:GRANGER
Suffix:
Gender:F
Credentials:DNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8415 METZGER AVE UNIT A
Mailing Address - Street 2:
Mailing Address - City:JBER
Mailing Address - State:AK
Mailing Address - Zip Code:99506-2025
Mailing Address - Country:US
Mailing Address - Phone:402-926-8352
Mailing Address - Fax:
Practice Address - Street 1:8415 METZGER AVE UNIT A
Practice Address - Street 2:
Practice Address - City:JBER
Practice Address - State:AK
Practice Address - Zip Code:99506-2025
Practice Address - Country:US
Practice Address - Phone:402-926-8352
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-17
Last Update Date:2023-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK211546363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health