Provider Demographics
NPI:1609877042
Name:CASEY, KAREN (CNS)
Entity type:Individual
Prefix:
First Name:KAREN
Middle Name:
Last Name:CASEY
Suffix:
Gender:F
Credentials:CNS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2004 OLD GRANGER
Mailing Address - Street 2:
Mailing Address - City:TAYLOR
Mailing Address - State:TX
Mailing Address - Zip Code:76574-3568
Mailing Address - Country:US
Mailing Address - Phone:512-856-5551
Mailing Address - Fax:512-615-5188
Practice Address - Street 1:2004 OLD GRANGER
Practice Address - Street 2:
Practice Address - City:TAYLOR
Practice Address - State:TX
Practice Address - Zip Code:76574-3568
Practice Address - Country:US
Practice Address - Phone:512-856-5551
Practice Address - Fax:512-615-5188
Is Sole Proprietor?:No
Enumeration Date:2005-08-09
Last Update Date:2024-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX664298207RC0000X, 364SA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SA2200XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistAdult Health
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1638496-01Medicaid
TX1638496-01Medicaid
TXTXB106316Medicare PIN