Provider Demographics
NPI:1558969428
Name:CHARLES, RYLEE
Entity type:Individual
Prefix:
First Name:RYLEE
Middle Name:
Last Name:CHARLES
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:RYLEE
Other - Middle Name:
Other - Last Name:CARTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CARTER
Mailing Address - Street 1:401 OLD PLEASANT GROVE RD APT 938
Mailing Address - Street 2:
Mailing Address - City:MOUNT JULIET
Mailing Address - State:TN
Mailing Address - Zip Code:37122-7317
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7450 TYNER RD
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37421-1078
Practice Address - Country:US
Practice Address - Phone:423-698-6871
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-13
Last Update Date:2025-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000216853163W00000X
TN28893367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse