Provider Demographics
NPI:1386386183
Name:WALDEN, KACI ELIZABETH (LPN)
Entity type:Individual
Prefix:MRS
First Name:KACI
Middle Name:ELIZABETH
Last Name:WALDEN
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:334 EAGLE LANE
Mailing Address - Street 2:
Mailing Address - City:EVENSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37332
Mailing Address - Country:US
Mailing Address - Phone:423-775-7819
Mailing Address - Fax:
Practice Address - Street 1:334 EAGLE LANE
Practice Address - Street 2:
Practice Address - City:EVENSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37332
Practice Address - Country:US
Practice Address - Phone:423-775-7819
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-12
Last Update Date:2022-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNLPN0000096574164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse