Provider Demographics
NPI:1356606479
Name:SCHULTZ, CASEY LYNN (PA-C)
Entity type:Individual
Prefix:MRS
First Name:CASEY
Middle Name:LYNN
Last Name:SCHULTZ
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:CASEY
Other - Middle Name:LYNN
Other - Last Name:MILLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:2005 TECHNOLOGY PKWY STE 300
Mailing Address - Street 2:
Mailing Address - City:MECHANICSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17050-9423
Mailing Address - Country:US
Mailing Address - Phone:717-988-5864
Mailing Address - Fax:717-221-5615
Practice Address - Street 1:2005 TECHNOLOGY PKWY STE 300
Practice Address - Street 2:
Practice Address - City:MECHANICSBURG
Practice Address - State:PA
Practice Address - Zip Code:17050-9423
Practice Address - Country:US
Practice Address - Phone:717-988-5864
Practice Address - Fax:717-221-5615
Is Sole Proprietor?:No
Enumeration Date:2012-07-05
Last Update Date:2022-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA055525363AM0700X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA103177106Medicaid
PA103177106Medicaid