Healthcare Provider Details

I. General information

NPI: 1518800762
Provider Name (Legal Business Name): MR. CASEY HENRY
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/13/2026
Last Update Date: 04/13/2026
Certification Date: 04/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1008 N 3RD ST
MONROE LA
71201-5246
US

IV. Provider business mailing address

1008 N 3RD ST
MONROE LA
71201-5246
US

V. Phone/Fax

Practice location:
  • Phone: 318-388-6808
  • Fax:
Mailing address:
  • Phone: 318-388-6808
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246Z00000X
TaxonomyOther Specialist/Technologist
License Number013302752
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: