Healthcare Provider Details

I. General information

NPI: 1295151686
Provider Name (Legal Business Name): CASEY LULAY FNP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/10/2014
Last Update Date: 05/31/2025
Certification Date: 05/31/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

41805 STAYTON SCIO RD SE
STAYTON OR
97383-9739
US

IV. Provider business mailing address

PO BOX 118
STAYTON OR
97383-0118
US

V. Phone/Fax

Practice location:
  • Phone: 503-507-5356
  • Fax: 866-225-2708
Mailing address:
  • Phone: 503-507-5356
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP60451155
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number201404020NP-PP
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: