Basic Information
| Provider Information | |||||||||
| NPI: | 1548293475 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CASEY | ||||||||
| FirstName: | SANDRA | ||||||||
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| Credential: | NP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1870 AMHERST ST | ||||||||
| Address2: | SUITE 1-C | ||||||||
| City: | WINCHESTER | ||||||||
| State: | VA | ||||||||
| PostalCode: | 226012873 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5405362579 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1840 AMHERST ST | ||||||||
| Address2: | |||||||||
| City: | WINCHESTER | ||||||||
| State: | VA | ||||||||
| PostalCode: | 226012808 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5405368700 | ||||||||
| FaxNumber: | 5405367800 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/07/2006 | ||||||||
| LastUpdateDate: | 03/31/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/31/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | 0024166771 | VA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
ID Information
| ID | Type | State | Issuer | Description | 0024166771 | 01 | VA | STATE LICENSE NUMBER | OTHER | 001839466 | 01 | VA | MOUNTAIN STATE BCBS | OTHER | 010269563 | 05 | VA | MEDICAID | 289216 | 01 | VA | ANTHEM BCBS | OTHER |