=====================================================
General NPI Number Information
=====================================================
NPI Number | 1679976088
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ASHLEY KAYLEENA KAAKE
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/30/2014
-----------------------------------------------------
Last Update Date | 05/21/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 317 N KING ST STE A
-----------------------------------------------------
City | HENDERSONVILLE
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28792-4349
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 828-693-3344
-----------------------------------------------------
Fax | 828-692-2487
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 360
-----------------------------------------------------
City | SYLVA
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28779-0360
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 888-339-6065
-----------------------------------------------------
Fax | 828-538-4441
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LG0600X
-----------------------------------------------------
Taxonomy Name | Gerontology Nurse Practitioner
-----------------------------------------------------
License Number | 265965
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 363L00000X
-----------------------------------------------------
Taxonomy Name | Nurse Practitioner
-----------------------------------------------------
License Number | 265965
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------