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General NPI Number Information
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NPI Number | 1609239938
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Entity Type | Individual
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Provider Name | CASEY CRUMP PETERSON NP-C
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Gender | Female
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Dates
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Enumeration Date | 04/04/2016
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Last Update Date | 11/17/2021
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Provider Practice Location Address
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Address Line | 40 S MAIN ST STE 1300
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City | MEMPHIS
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State | TN
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Zip | 38103-5513
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Country | US
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Telephone | 866-949-0108
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Fax | 866-620-4792
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Provider Business Mailing Address
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Address Line | PROSPERO HEALTH PARTNERS PC PROMENADE II 1230 PEACHTREE ST. NE 19TH FLOOR
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City | ATLANTA
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State | GA
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Zip | 30309-3574
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Country | US
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Telephone | 866-949-0108
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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 | RN214257
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License Number State | GA
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