Healthcare Provider Details

I. General information

NPI: 1366347593
Provider Name (Legal Business Name): CASEY JO BICE RN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/08/2026
Last Update Date: 10/08/2026
Certification Date: 10/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

585 E RIVERSIDE DR
ST GEORGE UT
84790-7141
US

IV. Provider business mailing address

585 E RIVERSIDE DR
ST GEORGE UT
84790-7141
US

V. Phone/Fax

Practice location:
  • Phone: 435-634-7608
  • Fax:
Mailing address:
  • Phone: 435-634-7608
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP2201X
TaxonomyAmbulatory Care Registered Nurse
License Number12794874-3102
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: