Healthcare Provider Details

I. General information

NPI: 1861069486
Provider Name (Legal Business Name): CAITLIN MAUREEN CASEY FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2021
Last Update Date: 11/15/2024
Certification Date: 11/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

119 CROSSOVER RD
BEULAVILLE NC
28518-8801
US

IV. Provider business mailing address

PO BOX 187
FAISON NC
28341-0187
US

V. Phone/Fax

Practice location:
  • Phone: 312-591-0298
  • Fax:
Mailing address:
  • Phone: 910-267-0421
  • Fax: 855-705-0022

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number5014529
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: