Casey Jeanne Chisum, FNP
Individual provider Active NPI Family Nurse Practitioner · Willis, TX
NPI 1972199396 · NPPES record last updated Dec 19, 2020
Key facts
- NPI
- 1972199396
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Nurse Practitioner 363LF0000X
- License
- 883143 (TX)
- Practice address
- 14723 Turquoise TRL
Willis, TX 77378-6601 - Phone
- (281) 253-6646
- NPI assigned
- Dec 19, 2020
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in TX
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20211208001364 | TX | Order and Referring Only - Nurse Practitioner | 4183014053 |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 883143 | TX | MD | Family Nurse Practitioner |
Interoperability endpoints
- casey.chisum@cfdp.eclinicaldirectplus.com
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Nurse | 163W00000X | 883143 | TX | |
| Family Nurse Practitioner | 363LF0000X | 883143 | TX | Yes |
Addresses
Primary practice location
14723 Turquoise TRL
Willis, TX 77378-6601
Mailing address
14723 Turquoise TRL
Willis, TX 77378-6601
Phone (281) 253-6646
Other providers in Willis, TX
- Andrew Carroll
- Yazmine Carter
- Amber Elise Castleschouldt
- Chad Fussell
- Valerie Collins Chartier
- Clark Pharmacy LLC
- Comfort Hands & Nursing LLC
- Community Guided Living 'CGL'
- Conroe Willis Family Medicine PLLC
- Cosmos Hospice of Piney Woods, LLC
All providers in Willis, TX · Family Nurse Practitioner in Texas
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 19, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.