Provider Demographics
NPI:1457449506
Name:ECHERE, KAKA (PSYCHIATRIC NP)
Entity Type:Individual
Prefix:
First Name:KAKA
Middle Name:
Last Name:ECHERE
Suffix:
Gender:M
Credentials:PSYCHIATRIC NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3414 OCONNOR LN
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37042-7982
Mailing Address - Country:US
Mailing Address - Phone:706-951-3944
Mailing Address - Fax:706-951-3944
Practice Address - Street 1:650 JOEL DR
Practice Address - Street 2:
Practice Address - City:FORT CAMPBELL
Practice Address - State:KY
Practice Address - Zip Code:42223
Practice Address - Country:US
Practice Address - Phone:270-798-5179
Practice Address - Fax:270-798-6075
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2018-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1581364SP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0808XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000606317BMedicaid
1457449506OtherNIP