Healthcare Provider Details

I. General information

NPI: 1336057587
Provider Name (Legal Business Name): CASEN HIPP CONNOR
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/29/2026
Last Update Date: 08/29/2026
Certification Date: 08/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

104 GARLAND CREST CT S
TULLAHOMA TN
37388-5437
US

IV. Provider business mailing address

104 GARLAND CREST CT S
TULLAHOMA TN
37388-5437
US

V. Phone/Fax

Practice location:
  • Phone: 931-581-0562
  • Fax:
Mailing address:
  • Phone: 931-581-0562
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number260682
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: