Individual
KELLY J. CASSEDY
Active
Individual
KELLY J. CASSEDY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
23468
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0218543000
—
WV
01
—
300066625
PGBA (RR MEDICARE)
—
01
—
3058511
BCBS
TN
05
—
3070168
—
TN
05
—
64927528
—
KY
05
—
7213425
—
VA
01
—
RO6903
JOHN DEERE
TN
Enumeration date
08/09/2005
Last updated
07/11/2023
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