Basic Information
| Provider Information | |||||||||
| NPI: | 1710357108 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CASEY | ||||||||
| FirstName: | KATHERINE | ||||||||
| MiddleName: | ROSE | ||||||||
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| Credential: | AGACNP-BC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5800 OAKDALE RD SE UNIT 154 | ||||||||
| Address2: | |||||||||
| City: | MABLETON | ||||||||
| State: | GA | ||||||||
| PostalCode: | 301265772 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7704029038 | ||||||||
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| Practice Location | |||||||||
| Address1: | 5667 PEACHTREE DUNWOODY RD | ||||||||
| Address2: | |||||||||
| City: | ATLANTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 30342 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6788437001 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/29/2015 | ||||||||
| LastUpdateDate: | 06/18/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | RN207488 | GA | N | Nursing Service Providers | Registered Nurse | 363L00000X | RN207488 | GA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
No ID Information.