1912261868 NPI number — MRS. DANNA SMITH CASTLEMAN PA-C

Table of content: MRS. DANNA SMITH CASTLEMAN PA-C (NPI 1912261868)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1912261868 NPI number — MRS. DANNA SMITH CASTLEMAN PA-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CASTLEMAN
Provider First Name:
DANNA
Provider Middle Name:
SMITH
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
PA-C
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SMITH
Provider Other First Name:
DANNA
Provider Other Middle Name:
DELISE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
P.A.-C
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1912261868
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/07/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 400
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
JACKSON
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
38302-0400
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
731-425-5752
Provider Business Mailing Address Fax Number:
731-425-5783

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
22 2ND AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HUNTINGDON
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
38344-3806
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
731-422-0213
Provider Business Practice Location Address Fax Number:
731-868-4766
Provider Enumeration Date:
06/26/2012

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: 363A00000X , with the licence number:  2440 , 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)

  • Identifier: Q014365 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".




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