Healthcare Provider Details

I. General information

NPI: 1497548614
Provider Name (Legal Business Name): KASEY NICOLE GILES
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/28/2025
Last Update Date: 04/30/2026
Certification Date: 04/30/2026
Deactivation Date: 07/03/2025
Reactivation Date: 08/11/2025

III. Provider practice location address

4370 W MAIN ST
DOTHAN AL
36305-1056
US

IV. Provider business mailing address

11805 CEDAR SPRINGS RD
BLAKELY GA
39823-9481
US

V. Phone/Fax

Practice location:
  • Phone: 334-793-5000
  • Fax:
Mailing address:
  • Phone: 229-723-1248
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number3-002473
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License Number226296
License Number StateTN
# 3
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number154485
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: