Provider Demographics
NPI:1356844518
Name:CASEY, KYLE LAWRENCE (AGNP-C)
Entity Type:Individual
Prefix:MR
First Name:KYLE
Middle Name:LAWRENCE
Last Name:CASEY
Suffix:
Gender:M
Credentials:AGNP-C
Other - Prefix:
Other - First Name:KYLE
Other - Middle Name:LAWRENCE
Other - Last Name:WULPERN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2004 HAYES ST STE 800
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37203-2659
Mailing Address - Country:US
Mailing Address - Phone:615-329-0570
Mailing Address - Fax:615-329-0579
Practice Address - Street 1:979 E 3RD ST STE A0550
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37403
Practice Address - Country:US
Practice Address - Phone:423-778-9250
Practice Address - Fax:423-778-8182
Is Sole Proprietor?:No
Enumeration Date:2018-03-14
Last Update Date:2020-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN23973363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology