Provider Demographics
NPI:1902293004
Name:WEGENER, CASEY (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:CASEY
Middle Name:
Last Name:WEGENER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MS
Other - First Name:CASEY
Other - Middle Name:
Other - Last Name:MOSER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:7136 S OUTER 364
Mailing Address - Street 2:
Mailing Address - City:O FALLON
Mailing Address - State:MO
Mailing Address - Zip Code:63368-7756
Mailing Address - Country:US
Mailing Address - Phone:636-561-3277
Mailing Address - Fax:636-561-5280
Practice Address - Street 1:7136 S OUTER 364
Practice Address - Street 2:
Practice Address - City:O FALLON
Practice Address - State:MO
Practice Address - Zip Code:63368-7756
Practice Address - Country:US
Practice Address - Phone:636-561-3277
Practice Address - Fax:636-561-5280
Is Sole Proprietor?:No
Enumeration Date:2015-04-16
Last Update Date:2019-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2016020646363A00000X
IL085005404363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant