Provider Demographics
NPI:1982272803
Name:TENNEY, CASEY S
Entity Type:Individual
Prefix:
First Name:CASEY
Middle Name:S
Last Name:TENNEY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 32
Mailing Address - Street 2:
Mailing Address - City:ADRIAN
Mailing Address - State:WV
Mailing Address - Zip Code:26210-0032
Mailing Address - Country:US
Mailing Address - Phone:304-924-5889
Mailing Address - Fax:
Practice Address - Street 1:10 WATERLOO RD
Practice Address - Street 2:
Practice Address - City:FRENCH CREEK
Practice Address - State:WV
Practice Address - Zip Code:26218-7345
Practice Address - Country:US
Practice Address - Phone:304-924-5889
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-16
Last Update Date:2021-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant