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General NPI Number Information
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NPI Number | 1023524196
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Entity Type | Individual
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Provider Name | CASEY JOE SMITH FNPC
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Gender | Male
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Dates
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Enumeration Date | 12/27/2017
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Last Update Date | 01/29/2025
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Provider Practice Location Address
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Address Line | 312 S 950 W
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City | HEYBURN
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State | ID
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Zip | 83336-9765
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Country | US
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Telephone | 801-484-4479
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Fax | 844-965-9279
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Provider Business Mailing Address
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Address Line | 312 S 950 W
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City | HEYBURN
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State | ID
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Zip | 83336-9765
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Country | US
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Telephone | 801-564-4479
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Fax | 844-965-9279
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 70138
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License Number State | ID
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