Provider Demographics
NPI:1376594317
Name:KACHELMYER, DANIEL LAURENCE (PA-C)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:LAURENCE
Last Name:KACHELMYER
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 E ECONOMY RD
Mailing Address - Street 2:SUITE 8
Mailing Address - City:MORRISTOWN
Mailing Address - State:TN
Mailing Address - Zip Code:37814-3388
Mailing Address - Country:US
Mailing Address - Phone:423-581-1533
Mailing Address - Fax:423-587-1729
Practice Address - Street 1:400 E ECONOMY RD
Practice Address - Street 2:SUITE 8
Practice Address - City:MORRISTOWN
Practice Address - State:TN
Practice Address - Zip Code:37814-3388
Practice Address - Country:US
Practice Address - Phone:423-581-1533
Practice Address - Fax:423-587-1729
Is Sole Proprietor?:No
Enumeration Date:2006-05-15
Last Update Date:2015-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1135363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4212412OtherBLUE CROSS BLUE SHIELD TN
TN4212412OtherBLUE CROSS BLUE SHIELD TN
TN36623681Medicare PIN