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NPI Code Detail

MEDICARE: CASEY CORNER ODO PA-C

MEDICARE: CASEY CORNER ODO PA-C
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
1363A00000XPhysician Assistant312955LA

General Provider Information

NPI Number : 1972162311
Entity Type Code : Individual
Provider Name (Legal Business Name) : CASEY CORNER ODO PA-C
Provider Business Mailing Address
First Line : 9034 SOUTHLAWN DR
Second Line :
City : BATON ROUGE
State : LA
Zip : 70810-2680
Country : US
Telephone Number : 318-305-5573
Fax Number :
Provider Business Practice Location Address
First Line : 2840 FLORIDA BLVD
Second Line :
City : BATON ROUGE
State : LA
Zip : 70802-2721
Country : US
Telephone Number : 225-224-8690
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/10/2019
Last Update Date : 05/10/2021

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Directions to “ CASEY CORNER ODO PA-C” Practice Location

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