| Doctor Name: | MR. CASEY MICHAEL FAVRE |
| NPI Number: | 1073806246 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | NP-C |
| License Number: | R875413 |
| Business Practice Address: | 4540 B Shepherds Squard Diamondhead, MS - 39525 |
| Business Phone Number: | 2282558216 |
| Business Fax Number: | 2282558219 |
| Mailing Address: | 149 Drinkwater Rd, BAY ST LOUIS |
| State: | MS |
| Postal Code: | 395201658 |
| Phone Number: | 2284678600 |
| Fax Number: | |
| NPI Enumeration Date: | 05/22/2011 |
| NPI Last Update Date: | 01/17/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LA2100X |
| License Number: | R875413 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | MS |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Acute Care |
| Taxonomy Definition: | |