Provider Demographics
NPI:1134438674
Name:TYNES, CASIE KEATON (AUD)
Entity type:Individual
Prefix:
First Name:CASIE
Middle Name:KEATON
Last Name:TYNES
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3161 HIGHWAY 64 STE 500
Mailing Address - Street 2:
Mailing Address - City:EADS
Mailing Address - State:TN
Mailing Address - Zip Code:38028-3370
Mailing Address - Country:US
Mailing Address - Phone:803-367-2355
Mailing Address - Fax:803-367-2355
Practice Address - Street 1:3161 HIGHWAY 64 STE 500
Practice Address - Street 2:
Practice Address - City:EADS
Practice Address - State:TN
Practice Address - Zip Code:38028-3370
Practice Address - Country:US
Practice Address - Phone:803-367-2355
Practice Address - Fax:803-367-2355
Is Sole Proprietor?:No
Enumeration Date:2010-10-01
Last Update Date:2013-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1679231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist