Basic Information
| Provider Information | |||||||||
| NPI: | 1457449506 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ECHERE | ||||||||
| FirstName: | KAKA | ||||||||
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| Credential: | PSYCHIATRIC NP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3414 OCONNOR LN | ||||||||
| Address2: | |||||||||
| City: | CLARKSVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 370427982 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7069513944 | ||||||||
| FaxNumber: | 7069513944 | ||||||||
| Practice Location | |||||||||
| Address1: | 650 JOEL DR | ||||||||
| Address2: | |||||||||
| City: | FORT CAMPBELL | ||||||||
| State: | KY | ||||||||
| PostalCode: | 42223 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2707985179 | ||||||||
| FaxNumber: | 2707986075 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/11/2006 | ||||||||
| LastUpdateDate: | 06/19/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 364SP0808X | 1581 | TX | Y | Physician Assistants & Advanced Practice Nursing Providers | Clinical Nurse Specialist | Psych/Mental Health |
ID Information
| ID | Type | State | Issuer | Description | 000606317B | 05 | GA | MEDICAID | 1457449506 | 01 | NIP | OTHER |