Individual
CASEY LANE EDWARDS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
24774 S 4090 RD, CLAREMORE, OK 74019-2298
(918) 519-1284
Mailing address
24774 S 4090 RD, CLAREMORE, OK 74019-2298
(918) 519-1284
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
—
—
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Enumeration date
09/24/2024
Last updated
09/24/2024
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