Provider Demographics
NPI:1811686850
Name:WALDRON, KASEY CARLISLE
Entity type:Individual
Prefix:MR
First Name:KASEY
Middle Name:CARLISLE
Last Name:WALDRON
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 1:211 HILLCREST AVE
Mailing Address - Street 2:
Mailing Address - City:BELTON
Mailing Address - State:SC
Mailing Address - Zip Code:29627-1219
Mailing Address - Country:US
Mailing Address - Phone:757-698-6050
Mailing Address - Fax:
Practice Address - Street 1:211 HILLCREST AVE
Practice Address - Street 2:
Practice Address - City:BELTON
Practice Address - State:SC
Practice Address - Zip Code:29627-1219
Practice Address - Country:US
Practice Address - Phone:757-698-6050
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-04
Last Update Date:2023-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)