Individual
CASEY WALL SOUTHARDS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP-C
Contact information
Practice address
162 COMMERCIAL ST, SUITE B, FOREST CITY, NC 28043-2849
(828) 287-9325
(828) 287-3594
Mailing address
162 COMMERCIAL ST, SUITE B, FOREST CITY, NC 28043-2849
(828) 287-9325
(828) 287-3594
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
5005745
NC
363LF0000X
Family Nurse Practitioner
Primary
5005745
NC
Other
Enumeration date
08/13/2012
Last updated
12/03/2015
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