Provider Demographics
NPI:1124688817
Name:COON, CASIE LAINE (FNP)
Entity type:Individual
Prefix:
First Name:CASIE
Middle Name:LAINE
Last Name:COON
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:135 DAISEY LN
Mailing Address - Street 2:
Mailing Address - City:JUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:76247-5808
Mailing Address - Country:US
Mailing Address - Phone:903-275-4458
Mailing Address - Fax:
Practice Address - Street 1:7510 N BEACH ST
Practice Address - Street 2:
Practice Address - City:FT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76137-1505
Practice Address - Country:US
Practice Address - Phone:817-498-1818
Practice Address - Fax:817-581-3761
Is Sole Proprietor?:No
Enumeration Date:2019-06-16
Last Update Date:2020-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF06190263363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily