Provider Demographics
NPI:1194905612
Name:CASEY, CHRISTOPHER H (PA-C)
Entity type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:H
Last Name:CASEY
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 SAINT VINCENT CIR STE 100
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72205-5415
Mailing Address - Country:US
Mailing Address - Phone:501-663-6455
Mailing Address - Fax:501-663-4877
Practice Address - Street 1:5 SAINT VINCENT CIR STE 100
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205-5415
Practice Address - Country:US
Practice Address - Phone:501-663-6455
Practice Address - Fax:501-663-4877
Is Sole Proprietor?:No
Enumeration Date:2007-11-13
Last Update Date:2009-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
363AM0700X, 363AS0400X
ARPA-320363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
P00603048OtherRR MEDICARE
5C201PA74Medicare PIN