=====================================================
General NPI Number Information
=====================================================
NPI Number | 1992668610
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CASEY WHITELEY NP-C
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/09/2025
-----------------------------------------------------
Last Update Date | 12/09/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1544 EUREKA RD STE 160
-----------------------------------------------------
City | ROSEVILLE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95661-3092
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 916-772-0200
-----------------------------------------------------
Fax | 916-772-0218
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4000 HOLLYWOOD BLVD STE 215S
-----------------------------------------------------
City | HOLLYWOOD
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33021-1227
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 206-474-3049
-----------------------------------------------------
Fax | 206-360-6020
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363L00000X
-----------------------------------------------------
Taxonomy Name | Nurse Practitioner
-----------------------------------------------------
License Number | 95037842
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------