Provider Demographics
NPI:1316289408
Name:WADDLE, CASEY M (NP)
Entity type:Individual
Prefix:MRS
First Name:CASEY
Middle Name:M
Last Name:WADDLE
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Gender:F
Credentials:NP
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Mailing Address - Street 1:605 GLENWOOD DRIVE, SUITE 103
Mailing Address - Street 2:CHI MEMORIAL BREAST CARE ASSOCIATES OF CHATTANOOGA
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37404
Mailing Address - Country:US
Mailing Address - Phone:423-698-0304
Mailing Address - Fax:423-622-7068
Practice Address - Street 1:605 GLENWOOD DRIVE, SUITE 103
Practice Address - Street 2:CHI MEMORIAL BREAST CARE ASSOCIATES OF CHATTANOOGA
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37404
Practice Address - Country:US
Practice Address - Phone:423-698-0304
Practice Address - Fax:423-622-7068
Is Sole Proprietor?:No
Enumeration Date:2013-03-26
Last Update Date:2016-10-21
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Provider Licenses
StateLicense IDTaxonomies
TN17503363LF0000X
GA209762363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily