Provider Demographics
NPI:1669145801
Name:JAEKLE, CASEY S
Entity type:Individual
Prefix:
First Name:CASEY
Middle Name:S
Last Name:JAEKLE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6275 UNIVERSITY DR NW STE 37-208
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35806-1776
Mailing Address - Country:US
Mailing Address - Phone:256-468-4048
Mailing Address - Fax:
Practice Address - Street 1:6275 UNIVERSITY DR NW STE 37-208
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35806-1776
Practice Address - Country:US
Practice Address - Phone:256-468-4048
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-25
Last Update Date:2021-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant