Healthcare Provider Details

I. General information

NPI: 1609102201
Provider Name (Legal Business Name): CASEY ANN OWINGS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/02/2009
Last Update Date: 06/23/2020
Certification Date: 06/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

521 MARTIN LUTHER KING JR WAY
TACOMA WA
98405-4238
US

IV. Provider business mailing address

4700 POINT FOSDICK DR STE 202
GIG HARBOR WA
98335-1706
US

V. Phone/Fax

Practice location:
  • Phone: 253-403-2900
  • Fax:
Mailing address:
  • Phone: 253-858-9192
  • Fax: 253-857-1489

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAP60489781
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number733792
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License NumberAP60489781
License Number StateWA
# 4
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP60489781
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: