Provider Demographics
NPI:1285410829
Name:WATERS, CASEY (APRN, CNP)
Entity type:Individual
Prefix:
First Name:CASEY
Middle Name:
Last Name:WATERS
Suffix:
Gender:F
Credentials:APRN, CNP
Other - Prefix:
Other - First Name:CASEY
Other - Middle Name:
Other - Last Name:MILLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:298 CHIPPEWA CT
Mailing Address - Street 2:
Mailing Address - City:SPARLAND
Mailing Address - State:IL
Mailing Address - Zip Code:61565-9401
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6339 N BIG HOLLOW RD
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61615-2907
Practice Address - Country:US
Practice Address - Phone:309-693-3315
Practice Address - Fax:309-693-9385
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-07
Last Update Date:2025-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209028235363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily