Healthcare Provider Details

I. General information

NPI: 1841633732
Provider Name (Legal Business Name): JOHN CASEY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/10/2013
Last Update Date: 10/20/2021
Certification Date: 10/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1330 ROCKEFELLER AVE STE 140
EVERETT WA
98201-1682
US

IV. Provider business mailing address

1321 COLBY AVE
EVERETT WA
98201-1665
US

V. Phone/Fax

Practice location:
  • Phone: 425-261-4210
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084F0202X
TaxonomyForensic Psychiatry Physician
License NumberE-10068
License Number StateAR
# 2
Primary TaxonomyN
Taxonomy Code2084F0202X
TaxonomyForensic Psychiatry Physician
License NumberMD61042709
License Number StateWA
# 3
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberE-10068
License Number StateAR
# 4
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberMD61042709
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: