Active NPI
Carson Caudill, PTA
- Physical Therapy Assistant
- Fort Campbell, KY
National Provider Identifier
1659408755
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapy Assistant
- License
- PTA3511
- Practice address
- 650 Joel Dr
Fort Campbell, KY 42223-5318 - Phone
- (270) 798-8102
- NPI assigned
- Feb 27, 2007
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapy Assistant | 225200000X | PTA3511 | TN | Primary |
Addresses
Primary practice location
650 Joel Dr
Fort Campbell, KY 42223-5318
Mailing address
509 Double Branch Rd
Dickson, TN 37055-3800
Phone (615) 308-8799
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PTA3511 | TN | MD | Physical Therapy Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1172534400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1762128000000",
"number": "1659408755",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "509 DOUBLE BRANCH RD",
"city": "DICKSON",
"state": "TN",
"postal_code": "370553800",
"telephone_number": "615-308-8799"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "650 JOEL DR",
"city": "FORT CAMPBELL",
"state": "KY",
"postal_code": "422235318",
"telephone_number": "270-798-8102"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CAUDILL",
"first_name": "CARSON",
"name_prefix": "Mr.",
"credential": "PTA",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-02-27",
"last_updated": "2025-11-03",
"certification_date": "2025-11-03",
"status": "A"
},
"taxonomies": [
{
"code": "225200000X",
"taxonomy_group": "",
"desc": "Physical Therapy Assistant",
"state": "TN",
"license": "PTA3511",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fort Campbell, KY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 3, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.