Provider Demographics
NPI:1720823867
Name:KEAST, CASEY (AGNP-C)
Entity type:Individual
Prefix:
First Name:CASEY
Middle Name:
Last Name:KEAST
Suffix:
Gender:F
Credentials:AGNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30600 NORTHWESTERN HWY
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48334-3161
Mailing Address - Country:US
Mailing Address - Phone:844-475-9526
Mailing Address - Fax:
Practice Address - Street 1:30600 NORTHWESTERN HWY STE 245
Practice Address - Street 2:
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48334-3171
Practice Address - Country:US
Practice Address - Phone:844-475-9526
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-29
Last Update Date:2025-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704318274NSA240IH363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner