MEDICARE: CASEY CORCORAN SMITH

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	363LF0000X	Family Nurse Practitioner	213615	LA

General Provider Information

NPI Number	:	1689506289
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CASEY CORCORAN SMITH

Provider Business Mailing Address
First Line	:	16939 RIVER BIRCH AVE
Second Line	:
City	:	GREENWELL SPRINGS
State	:	LA
Zip	:	70739-5753
Country	:	US
Telephone Number	:	504-810-1048
Fax Number	:

Provider Business Practice Location Address
First Line	:	10222 JEFFERSON HWY
Second Line	:
City	:	BATON ROUGE
State	:	LA
Zip	:	70809-2727
Country	:	US
Telephone Number	:	225-765-1982
Fax Number	:

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

Provider Enumeration Date	:	05/30/2026
Last Update Date	:	05/30/2026

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