Provider Demographics
NPI:1285909887
Name:CASEY, JESSICA D (PNP)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:D
Last Name:CASEY
Suffix:
Gender:F
Credentials:PNP
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:D
Other - Last Name:HERR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1919 E THOMAS RD
Mailing Address - Street 2:BLDG 2108, SUITE 101
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85016-7710
Mailing Address - Country:US
Mailing Address - Phone:602-512-8029
Mailing Address - Fax:602-512-8161
Practice Address - Street 1:1919 E THOMAS RD
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85016-7710
Practice Address - Country:US
Practice Address - Phone:602-933-0985
Practice Address - Fax:602-933-0323
Is Sole Proprietor?:No
Enumeration Date:2012-03-14
Last Update Date:2013-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN170733363LP0200X
AZAP4384363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics