Healthcare Provider Details

I. General information

NPI: 1275930893
Provider Name (Legal Business Name): CASEY POWERS CPNP-PC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/25/2014
Last Update Date: 04/04/2022
Certification Date: 04/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3741 ROME DR # B
LAFAYETTE IN
47905-4490
US

IV. Provider business mailing address

PO BOX 684
DERBY VT
05829-0684
US

V. Phone/Fax

Practice location:
  • Phone: 765-607-6160
  • Fax:
Mailing address:
  • Phone: 765-586-8406
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number71012449A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: