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NPI Code Detail

MEDICARE: CASEY DEVAUGHN FLEMING NP-C

MEDICARE: CASEY DEVAUGHN FLEMING NP-C
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
1363LF0000XFamily Nurse Practitioner9024867MS
2363L00000XNurse PractitionerFLEM-3C9YDBMS

General Provider Information

NPI Number : 1598263709
Entity Type Code : Individual
Provider Name (Legal Business Name) : CASEY DEVAUGHN FLEMING NP-C
Provider Business Mailing Address
First Line : 625 S MONTGOMERY ST APT 80
Second Line :
City : STARKVILLE
State : MS
Zip : 39759-3885
Country : US
Telephone Number : 662-416-1935
Fax Number :
Provider Business Practice Location Address
First Line : 14724 HIGHWAY 15 N
Second Line :
City : LOUISVILLE
State : MS
Zip : 39339-6318
Country : US
Telephone Number : 662-773-7500
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/23/2018
Last Update Date : 01/23/2018

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