Healthcare Provider Details

I. General information

NPI: 1992388714
Provider Name (Legal Business Name): MICHELLE CASEY FNTP, FDNP, CHHC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/29/2021
Last Update Date: 04/29/2021
Certification Date: 04/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

73-1485 HAO PL
KAILUA KONA HI
96740-8657
US

IV. Provider business mailing address

PO BOX 1837
KAILUA KONA HI
96745-1837
US

V. Phone/Fax

Practice location:
  • Phone: 206-395-9386
  • Fax:
Mailing address:
  • Phone: 808-468-6078
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: