Provider Demographics
NPI:1497548614
Name:GILES, KASEY NICOLE
Entity type:Individual
Prefix:
First Name:KASEY
Middle Name:NICOLE
Last Name:GILES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11805 CEDAR SPRINGS RD
Mailing Address - Street 2:
Mailing Address - City:BLAKELY
Mailing Address - State:GA
Mailing Address - Zip Code:39823-9481
Mailing Address - Country:US
Mailing Address - Phone:229-723-1248
Mailing Address - Fax:
Practice Address - Street 1:1450 ROSS CLARK CIR STE 4
Practice Address - Street 2:
Practice Address - City:DOTHAN
Practice Address - State:AL
Practice Address - Zip Code:36301-4736
Practice Address - Country:US
Practice Address - Phone:334-793-3442
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-28
Last Update Date:2025-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN226296163WC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine