Healthcare Provider Details

I. General information

NPI: 1609239938
Provider Name (Legal Business Name): CASEY CRUMP PETERSON NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/04/2016
Last Update Date: 11/17/2021
Certification Date: 11/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40 S MAIN ST STE 1300
MEMPHIS TN
38103-5513
US

IV. Provider business mailing address

PROSPERO HEALTH PARTNERS PC PROMENADE II 1230 PEACHTREE ST. NE 19TH FLOOR
ATLANTA GA
30309-3574
US

V. Phone/Fax

Practice location:
  • Phone: 866-949-0108
  • Fax: 866-620-4792
Mailing address:
  • Phone: 866-949-0108
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN214257
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: