Provider Demographics
NPI:1013916691
Name:CAGLE, MARSHA RENAE (NP)
Entity type:Individual
Prefix:
First Name:MARSHA
Middle Name:RENAE
Last Name:CAGLE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:304 WRIGHT ST
Mailing Address - Street 2:
Mailing Address - City:SWEETWATER
Mailing Address - State:TN
Mailing Address - Zip Code:37874-1181
Mailing Address - Country:US
Mailing Address - Phone:865-213-8590
Mailing Address - Fax:865-213-8596
Practice Address - Street 1:304 WRIGHT ST
Practice Address - Street 2:
Practice Address - City:SWEETWATER
Practice Address - State:TN
Practice Address - Zip Code:37874-1181
Practice Address - Country:US
Practice Address - Phone:865-213-8590
Practice Address - Fax:865-213-8596
Is Sole Proprietor?:No
Enumeration Date:2005-07-18
Last Update Date:2007-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN47633363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
4121590OtherBLUE CROSS
TN3928431Medicaid
3928431Medicare ID - Type Unspecified
TN3928431Medicaid