Healthcare Provider Details

I. General information

NPI: 1154928018
Provider Name (Legal Business Name): JAMES LESLIE CASEMENT RN,CNOR,RNFA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/05/2020
Last Update Date: 10/05/2020
Certification Date: 10/05/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1081 N CHINA LAKE BLVD
RIDGECREST CA
93555-3130
US

IV. Provider business mailing address

3301 SHILOH RANCH RD
BAKERSFIELD CA
93306-2444
US

V. Phone/Fax

Practice location:
  • Phone: 760-446-3551
  • Fax:
Mailing address:
  • Phone: 760-895-9245
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WR0006X
TaxonomyRegistered Nurse First Assistant
License Number809908
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code163WR0006X
TaxonomyRegistered Nurse First Assistant
License Number809980
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: