Provider Demographics
NPI:1912261868
Name:CASTLEMAN, DANNA SMITH (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:DANNA
Middle Name:SMITH
Last Name:CASTLEMAN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:DANNA
Other - Middle Name:DELISE
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:PO BOX 400
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:TN
Mailing Address - Zip Code:38302-0400
Mailing Address - Country:US
Mailing Address - Phone:731-425-5752
Mailing Address - Fax:731-425-5783
Practice Address - Street 1:20719 MAIN ST E
Practice Address - Street 2:
Practice Address - City:HUNTINGDON
Practice Address - State:TN
Practice Address - Zip Code:38344-4235
Practice Address - Country:US
Practice Address - Phone:731-986-2056
Practice Address - Fax:731-986-2352
Is Sole Proprietor?:No
Enumeration Date:2012-06-26
Last Update Date:2017-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2440363A00000X
KYPA1738363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ014365Medicaid
TN103I979110Medicare PIN