Casey Wall Southards, FNP-C

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

5005745 Issued in NC

Practice address

162 Commercial St
Suite B
Forest City, NC 28043-2849

Phone

(828) 287-9325

Fax

(828) 287-3594

NPI assigned

Aug 13, 2012

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1344816000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1449100800000",
    "number": "1609123306",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "162 COMMERCIAL ST",
            "address_2": "SUITE B",
            "city": "FOREST CITY",
            "state": "NC",
            "postal_code": "280432849",
            "telephone_number": "828-287-9325",
            "fax_number": "828-287-3594"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "162 COMMERCIAL ST",
            "address_2": "SUITE B",
            "city": "FOREST CITY",
            "state": "NC",
            "postal_code": "280432849",
            "telephone_number": "828-287-9325",
            "fax_number": "828-287-3594"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SOUTHARDS",
        "first_name": "CASEY",
        "middle_name": "WALL",
        "credential": "FNP-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-08-13",
        "last_updated": "2015-12-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "NC",
            "license": "5005745",
            "primary": true
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "NC",
            "license": "5005745",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Family Nurse Practitioner in Forest City, NC
• Providers in Forest City, NC by specialty
• Family Nurse Practitioner in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 3, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.