Active NPI
Casey Leigh Davis, PA-C
- Surgical Physician Assistant
- Saint Louis, MO
National Provider Identifier
1710201272
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Surgical Physician Assistant
- License
- 2011030386
- Practice address
- 2325 Dougherty Ferry Rd Ste 100
Saint Louis, MO 63122-3356 - Phone
- (314) 909-1359
- Fax
- (314) 909-1370
- NPI assigned
- Mar 26, 2010
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 4
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Emergency Medicine Physician | 207P00000X | 085.003693 | IL | |
| Physician Assistant | 363A00000X | 085.003693 | IL | |
| Physician Assistant | 363A00000X | 2011030386 | MO | |
| Surgical Physician Assistant | 363AS0400X | 2011030386 | MO | Primary |
Addresses
Primary practice location
2325 Dougherty Ferry Rd Ste 100
Saint Louis, MO 63122-3356
Mailing address
2325 Dougherty Ferry Rd
Suite 100
Saint Louis, MO 63122-3356
Phone (314) 909-1359
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 085.003693 | IL | MD | Physician Assistant |
| 2011030386 | MO | MD | Surgical Physician Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1269561600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1391126400000",
"number": "1710201272",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2325 DOUGHERTY FERRY RD",
"address_2": "SUITE 100",
"city": "SAINT LOUIS",
"state": "MO",
"postal_code": "631223356",
"telephone_number": "314-909-1359",
"fax_number": "314-909-1370"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2325 DOUGHERTY FERRY RD STE 100",
"city": "SAINT LOUIS",
"state": "MO",
"postal_code": "631223356",
"telephone_number": "314-909-1359",
"fax_number": "314-909-1370"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DAVIS",
"first_name": "CASEY",
"middle_name": "LEIGH",
"credential": "PA-C",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2010-03-26",
"last_updated": "2014-01-31",
"status": "A"
},
"taxonomies": [
{
"code": "207P00000X",
"taxonomy_group": "",
"desc": "Emergency Medicine",
"state": "IL",
"license": "085.003693",
"primary": false
},
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "IL",
"license": "085.003693",
"primary": false
},
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "MO",
"license": "2011030386",
"primary": false
},
{
"code": "363AS0400X",
"taxonomy_group": "",
"desc": "Physician Assistant, Surgical",
"state": "MO",
"license": "2011030386",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}
Other providers in Saint Louis, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 31, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.