Healthcare Provider Details

I. General information

NPI: 1851497473
Provider Name (Legal Business Name): MICHAEL CASKEY CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/15/2006
Last Update Date: 03/22/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

509 N BRIGHTLEAF BLVD
SMITHFIELD NC
27577-4407
US

IV. Provider business mailing address

350 INDIAN BOUNDARY RD
CHESTERTON IN
46304
US

V. Phone/Fax

Practice location:
  • Phone: 919-938-7188
  • Fax:
Mailing address:
  • Phone: 919-413-2046
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number176841
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: