Healthcare Provider Details

I. General information

NPI: 1255639977
Provider Name (Legal Business Name): CASEY CORBETT FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/03/2011
Last Update Date: 05/25/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3156 STATE ST
MEDFORD OR
97504-8450
US

IV. Provider business mailing address

595 N MAIN ST STE 2
ASHLAND OR
97520-1821
US

V. Phone/Fax

Practice location:
  • Phone: 541-773-9772
  • Fax: 541-773-1113
Mailing address:
  • Phone: 541-488-1116
  • Fax: 541-488-6409

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number201150004NP
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: