Individual
CASEY RYAN DIVIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
5414 FREDERICKSBURG RD STE 100A, SAN ANTONIO, TX 78229-3641
(210) 468-0800
Mailing address
20529 WIND SPGS, SAN ANTONIO, TX 78258-7457
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
AP135899
TX
Other
Enumeration date
11/21/2017
Last updated
01/20/2021
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