Healthcare Provider Details

I. General information

NPI: 1457449506
Provider Name (Legal Business Name): KAKA ECHERE PSYCHIATRIC NP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/11/2006
Last Update Date: 06/19/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

650 JOEL DR
FORT CAMPBELL KY
42223
US

IV. Provider business mailing address

3414 OCONNOR LN
CLARKSVILLE TN
37042-7982
US

V. Phone/Fax

Practice location:
  • Phone: 270-798-5179
  • Fax: 270-798-6075
Mailing address:
  • Phone: 706-951-3944
  • Fax: 706-951-3944

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SP0808X
TaxonomyPsychiatric/Mental Health Clinical Nurse Specialist
License Number1581
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: