Provider Demographics
NPI:1073133484
Name:O'BRIEN, CASEY M (PA-C)
Entity type:Individual
Prefix:
First Name:CASEY
Middle Name:M
Last Name:O'BRIEN
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:206 CORNELIA ST
Mailing Address - Street 2:
Mailing Address - City:PLATTSBURGH
Mailing Address - State:NY
Mailing Address - Zip Code:12901-2878
Mailing Address - Country:US
Mailing Address - Phone:518-561-5516
Mailing Address - Fax:
Practice Address - Street 1:426 INDUSTRIAL AVE STE 130
Practice Address - Street 2:
Practice Address - City:WILLISTON
Practice Address - State:VT
Practice Address - Zip Code:05495-4449
Practice Address - Country:US
Practice Address - Phone:802-878-1175
Practice Address - Fax:802-652-5355
Is Sole Proprietor?:No
Enumeration Date:2020-04-26
Last Update Date:2024-06-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VT055.0031747363A00000X
VT055.0031508363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant