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NPI Code Detail

MEDICARE: CASEY S CLARK PANTER CRNA

MEDICARE: CASEY S CLARK PANTER 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
1367500000XCertified Registered Nurse Anesthetist1-083267AL

General Provider Information

NPI Number : 1538137922
Entity Type Code : Individual
Provider Name (Legal Business Name) : CASEY S CLARK PANTER CRNA
Provider Business Mailing Address
First Line : PO BOX 1427
Second Line :
City : JASPER
State : AL
Zip : 35502-1427
Country : US
Telephone Number : 205-387-4741
Fax Number : 205-221-5474
Provider Business Practice Location Address
First Line : 3400 HIGHWAY 78 E
Second Line :
City : JASPER
State : AL
Zip : 35501-8907
Country : US
Telephone Number : 205-387-4741
Fax Number : 205-221-5474
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/10/2006
Last Update Date : 10/09/2007

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Directions to “ CASEY S CLARK PANTER CRNA” Practice Location

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