Provider Demographics
NPI:1346003787
Name:MCCASLIN, TARA KAITLYN (CPM, CLC)
Entity Type:Individual
Prefix:
First Name:TARA
Middle Name:KAITLYN
Last Name:MCCASLIN
Suffix:
Gender:F
Credentials:CPM, CLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6033 BELEW DR
Mailing Address - Street 2:
Mailing Address - City:MILAN
Mailing Address - State:TN
Mailing Address - Zip Code:38358-6415
Mailing Address - Country:US
Mailing Address - Phone:731-487-2069
Mailing Address - Fax:
Practice Address - Street 1:2064 US HIGHWAY 45 BYP S
Practice Address - Street 2:
Practice Address - City:TRENTON
Practice Address - State:TN
Practice Address - Zip Code:38382-3507
Practice Address - Country:US
Practice Address - Phone:731-487-2069
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-30
Last Update Date:2024-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN326038.174N00000X
CPM24040414176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife
No174N00000XOther Service ProvidersLactation Consultant, Non-RN