Healthcare Provider Details

I. General information

NPI: 1861327363
Provider Name (Legal Business Name): CASEY MARRIOTT APRN, FNP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2026
Last Update Date: 06/16/2026
Certification Date: 06/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26136 US HIGHWAY 59
FAIRFAX MO
64446-9105
US

IV. Provider business mailing address

217 W FLORENCE AVE
GLENWOOD IA
51534-1159
US

V. Phone/Fax

Practice location:
  • Phone: 660-686-2211
  • Fax:
Mailing address:
  • Phone: 402-917-1017
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2026027066
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: