Provider Demographics
NPI:1679066617
Name:SHEA, CASEY J (FNP-C)
Entity type:Individual
Prefix:
First Name:CASEY
Middle Name:J
Last Name:SHEA
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:113 E 6TH ST
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:26187-1601
Mailing Address - Country:US
Mailing Address - Phone:304-481-1375
Mailing Address - Fax:
Practice Address - Street 1:400 MATTHEW ST STE 303
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:OH
Practice Address - Zip Code:45750-1656
Practice Address - Country:US
Practice Address - Phone:740-373-7828
Practice Address - Fax:740-373-5898
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-13
Last Update Date:2020-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.024391363LF0000X
WVAPRN78641-NP-C363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0336236Medicaid