MEDICARE: MR. BENJAMIN R KADAS APN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	11266	TN

General Provider Information

NPI Number	:	1912975186
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. BENJAMIN R KADAS APN

Provider Business Mailing Address
First Line	:	775 FLEISCHMANN WAY
Second Line	:
City	:	CARSON CITY
State	:	NV
Zip	:	89703-2995
Country	:	US
Telephone Number	:	775-445-7756
Fax Number	:

Provider Business Practice Location Address
First Line	:	627 SMITHVIEW DR
Second Line	:
City	:	MARYVILLE
State	:	TN
Zip	:	37803-6100
Country	:	US
Telephone Number	:	865-380-4390
Fax Number	:	865-380-4396

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/14/2006
Last Update Date	:	07/11/2017

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