Provider Demographics
NPI:1811665433
Name:MCMAHON, CASEY (MSN, CRNP, FNP-C)
Entity type:Individual
Prefix:
First Name:CASEY
Middle Name:
Last Name:MCMAHON
Suffix:
Gender:F
Credentials:MSN, CRNP, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:824 S MACON ST
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21224-4439
Mailing Address - Country:US
Mailing Address - Phone:609-462-8274
Mailing Address - Fax:
Practice Address - Street 1:5100 FALLS RD STE 168
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21210-1935
Practice Address - Country:US
Practice Address - Phone:410-800-2134
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-30
Last Update Date:2021-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR215128363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily