Healthcare Provider Details

I. General information

NPI: 1205799111
Provider Name (Legal Business Name): CASEY LYN SMITH RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/08/2025
Last Update Date: 12/08/2025
Certification Date: 12/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

304 E VIRGINIA BLVD
JAMESTOWN NY
14701-8439
US

IV. Provider business mailing address

304 E VIRGINIA BLVD
JAMESTOWN NY
14701-8439
US

V. Phone/Fax

Practice location:
  • Phone: 716-661-0377
  • Fax:
Mailing address:
  • Phone: 716-661-0377
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number649458-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: