Provider Demographics
NPI:1215447552
Name:BYRD, CASEY (CPHT)
Entity type:Individual
Prefix:
First Name:CASEY
Middle Name:
Last Name:BYRD
Suffix:
Gender:M
Credentials:CPHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19118 ALBERTA ST
Mailing Address - Street 2:
Mailing Address - City:ONEIDA
Mailing Address - State:TN
Mailing Address - Zip Code:37841-6003
Mailing Address - Country:US
Mailing Address - Phone:423-569-9000
Mailing Address - Fax:423-569-2402
Practice Address - Street 1:19118 ALBERTA ST
Practice Address - Street 2:
Practice Address - City:ONEIDA
Practice Address - State:TN
Practice Address - Zip Code:37841-6003
Practice Address - Country:US
Practice Address - Phone:423-569-9000
Practice Address - Fax:423-569-2402
Is Sole Proprietor?:No
Enumeration Date:2017-09-30
Last Update Date:2017-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000035551183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician