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General NPI Number Information
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NPI Number | 1598263709
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Entity Type | Individual
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Provider Name | CASEY DEVAUGHN FLEMING NP-C
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Gender | Male
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Dates
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Enumeration Date | 01/23/2018
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Last Update Date | 01/23/2018
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Provider Practice Location Address
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Address Line | 14724 HIGHWAY 15 N
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City | LOUISVILLE
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State | MS
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Zip | 39339-6318
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Country | US
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Telephone | 662-773-7500
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Fax |
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Provider Business Mailing Address
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Address Line | 625 S MONTGOMERY ST APT 80
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City | STARKVILLE
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State | MS
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Zip | 39759-3885
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Country | US
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Telephone | 662-416-1935
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Fax |
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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 | 9024867
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License Number State | MS
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Taxonomy #2
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | FLEM-3C9YDB
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License Number State | MS
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