Healthcare Provider Details

I. General information

NPI: 1992668610
Provider Name (Legal Business Name): CASEY WHITELEY NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/09/2025
Last Update Date: 12/09/2025
Certification Date: 12/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1544 EUREKA RD STE 160
ROSEVILLE CA
95661-3092
US

IV. Provider business mailing address

4000 HOLLYWOOD BLVD STE 215S
HOLLYWOOD FL
33021-1227
US

V. Phone/Fax

Practice location:
  • Phone: 916-772-0200
  • Fax: 916-772-0218
Mailing address:
  • Phone: 206-474-3049
  • Fax: 206-360-6020

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number95037842
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: