Provider Demographics
NPI:1295883924
Name:CASEBEER, MARY ANN (ARNP CNS)
Entity type:Individual
Prefix:MRS
First Name:MARY
Middle Name:ANN
Last Name:CASEBEER
Suffix:
Gender:F
Credentials:ARNP CNS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1505 W 4TH ST
Mailing Address - Street 2:
Mailing Address - City:COFFEYVILLE
Mailing Address - State:KS
Mailing Address - Zip Code:67337-3307
Mailing Address - Country:US
Mailing Address - Phone:620-251-4040
Mailing Address - Fax:620-251-2803
Practice Address - Street 1:1505 W 4TH ST
Practice Address - Street 2:
Practice Address - City:COFFEYVILLE
Practice Address - State:KS
Practice Address - Zip Code:67337-3307
Practice Address - Country:US
Practice Address - Phone:620-251-4040
Practice Address - Fax:620-251-2803
Is Sole Proprietor?:No
Enumeration Date:2007-01-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS74147103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
015230Medicare ID - Type Unspecified