Provider Demographics
NPI:1538302385
Name:DESAI, CARA JO (LAC)
Entity Type:Individual
Prefix:
First Name:CARA
Middle Name:JO
Last Name:DESAI
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1494 SUGAR TREE KNOB RD
Mailing Address - Street 2:
Mailing Address - City:LIBERTY
Mailing Address - State:TN
Mailing Address - Zip Code:37095-9329
Mailing Address - Country:US
Mailing Address - Phone:615-900-4525
Mailing Address - Fax:
Practice Address - Street 1:1494 SUGAR TREE KNOB RD
Practice Address - Street 2:
Practice Address - City:LIBERTY
Practice Address - State:TN
Practice Address - Zip Code:37095-9329
Practice Address - Country:US
Practice Address - Phone:615-900-4525
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-09
Last Update Date:2021-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN379171100000X
TX1071171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist