1356844518 NPI number — MR. KYLE LAWRENCE CASEY AGNP-C

Table of content: MR. KYLE LAWRENCE CASEY AGNP-C (NPI 1356844518)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1356844518 NPI number — MR. KYLE LAWRENCE CASEY AGNP-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CASEY
Provider First Name:
KYLE
Provider Middle Name:
LAWRENCE
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
AGNP-C
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
WULPERN
Provider Other First Name:
KYLE
Provider Other Middle Name:
LAWRENCE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1356844518
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/30/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2004 HAYES ST STE 800
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NASHVILLE
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37203-2659
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
615-329-0570
Provider Business Mailing Address Fax Number:
615-329-0579

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
979 E 3RD ST STE A0550
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHATTANOOGA
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37403
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
423-778-9250
Provider Business Practice Location Address Fax Number:
423-778-8182
Provider Enumeration Date:
03/14/2018

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LG0600X , with the licence number:  23973 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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