Provider Demographics
NPI:1780607788
Name:HOOVER, CASEY M (FNP-C)
Entity type:Individual
Prefix:
First Name:CASEY
Middle Name:M
Last Name:HOOVER
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:515 12TH ST NE
Mailing Address - Street 2:
Mailing Address - City:DILWORTH
Mailing Address - State:MN
Mailing Address - Zip Code:56529
Mailing Address - Country:US
Mailing Address - Phone:701-361-8025
Mailing Address - Fax:701-234-4877
Practice Address - Street 1:4571 S WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:GRAND FORKS
Practice Address - State:ND
Practice Address - Zip Code:58201-7268
Practice Address - Country:US
Practice Address - Phone:701-757-3376
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2024-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR1717185363L00000X
ND29370363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND19829Medicaid
MN126677200Medicaid
MN500003309Medicare PIN
ND713238Medicare PIN
ND19829Medicaid