Healthcare Provider Details

I. General information

NPI: 1528378122
Provider Name (Legal Business Name): CASEY JO CIRINO FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/15/2010
Last Update Date: 11/15/2023
Certification Date: 11/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

902 KIRKWOOD AVE NW
LENOIR NC
28645-5121
US

IV. Provider business mailing address

2108 CLAYTON PL
HATTIESBURG MS
39402-2805
US

V. Phone/Fax

Practice location:
  • Phone: 828-754-0101
  • Fax: 828-757-0402
Mailing address:
  • Phone: 601-602-2014
  • Fax: 601-602-2015

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number5017706
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number5017706
License Number StateNC
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR876991
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: