Individual
MR. CASEY MICHAEL FAVRE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
NP-C
Contact information
Practice address
4540 B SHEPHERDS SQUARD, DIAMONDHEAD, MS 39525
(228) 255-8216
(228) 255-8219
Mailing address
149 DRINKWATER RD, BAY ST LOUIS, MS 39520-1658
(228) 467-8600
Taxonomy
Speciality
Code
Description
License number
State
363LA2100X
Acute Care Nurse Practitioner
R875413
MS
363LF0000X
Family Nurse Practitioner
Primary
R875413
MS
Other
Enumeration date
05/22/2011
Last updated
01/17/2014
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