Provider Demographics
NPI:1962180463
Name:MIDDLETON, KARA CHEYENNE
Entity type:Individual
Prefix:
First Name:KARA
Middle Name:CHEYENNE
Last Name:MIDDLETON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:412 LAWRENCE CIR UNIT A
Mailing Address - Street 2:
Mailing Address - City:FORT CAMPBELL
Mailing Address - State:KY
Mailing Address - Zip Code:42223-1248
Mailing Address - Country:US
Mailing Address - Phone:706-766-5663
Mailing Address - Fax:
Practice Address - Street 1:120 DUNBAR CAVE RD STE AB
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37043-8862
Practice Address - Country:US
Practice Address - Phone:931-538-3252
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-06
Last Update Date:2024-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician