Healthcare Provider Details

I. General information

NPI: 1053717546
Provider Name (Legal Business Name): AMY CASEY APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: AMY CASEY RN

II. Dates (important events)

Enumeration Date: 11/10/2014
Last Update Date: 03/31/2025
Certification Date: 03/31/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 E HARTFORD AVE
PONCA CITY OK
74601-2018
US

IV. Provider business mailing address

1201 E HARTFORD AVE
PONCA CITY OK
74601-2018
US

V. Phone/Fax

Practice location:
  • Phone: 580-762-1911
  • Fax:
Mailing address:
  • Phone: 580-762-1911
  • Fax: 580-762-0887

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number87170
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: