Provider Demographics
NPI:1720096159
Name:CASADY, BETH ANN (DO FAAFP)
Entity type:Individual
Prefix:
First Name:BETH
Middle Name:ANN
Last Name:CASADY
Suffix:
Gender:F
Credentials:DO FAAFP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 506
Mailing Address - Street 2:
Mailing Address - City:SPRING CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37381-0506
Mailing Address - Country:US
Mailing Address - Phone:423-365-0450
Mailing Address - Fax:888-355-6415
Practice Address - Street 1:126 LAVENDER ST
Practice Address - Street 2:
Practice Address - City:SPRING CITY
Practice Address - State:TN
Practice Address - Zip Code:37381-5102
Practice Address - Country:US
Practice Address - Phone:423-365-0450
Practice Address - Fax:888-355-6415
Is Sole Proprietor?:No
Enumeration Date:2006-08-03
Last Update Date:2025-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN840207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ010228Medicaid
TN3302741Medicaid
TN103I084510Medicare PIN