MEDICARE: MR. JOE VERNON CASEY JR. CRNA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	367500000X	Certified Registered Nurse Anesthetist	R0083727	OK
2	367500000X	Certified Registered Nurse Anesthetist	AP128983	TX
3	367500000X	Certified Registered Nurse Anesthetist	596812	CA
4	367500000X	Certified Registered Nurse Anesthetist	APRN.CRNA.17071	OH
5	367500000X	Certified Registered Nurse Anesthetist	C003278	AR

General Provider Information

NPI Number	:	1104825116
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JOE VERNON CASEY JR. CRNA

Provider Business Mailing Address
First Line	:	601 W MAPLE AVE STE 503
Second Line	:
City	:	SPRINGDALE
State	:	AR
Zip	:	72764-5376
Country	:	US
Telephone Number	:	479-751-3722
Fax Number	:	479-751-1099

Provider Business Practice Location Address
First Line	:	609 W MAPLE AVE
Second Line	:
City	:	SPRINGDALE
State	:	AR
Zip	:	72764-5335
Country	:	US
Telephone Number	:	479-751-5711
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/20/2005
Last Update Date	:	03/10/2022

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