MEDICARE: KELLY MARIE CASEY RNC-MNN, BSN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	390200000X	Student in an Organized Health Care Education/Training Program	201906669RN	OR

General Provider Information

NPI Number	:	1033035688
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KELLY MARIE CASEY RNC-MNN, BSN

Provider Business Mailing Address
First Line	:	2716 FENYA ST
Second Line	:
City	:	SPRINGFIELD
State	:	OR
Zip	:	97477-7951
Country	:	US
Telephone Number	:	541-521-1210
Fax Number	:

Provider Business Practice Location Address
First Line	:	3333 RIVERBEND DR
Second Line	:
City	:	SPRINGFIELD
State	:	OR
Zip	:	97477-8800
Country	:	US
Telephone Number	:	541-222-3993
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/27/2026
Last Update Date	:	06/27/2026

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