Provider Demographics
NPI:1013569508
Name:CAIN, CALEB (APRN, FNP-C)
Entity Type:Individual
Prefix:
First Name:CALEB
Middle Name:
Last Name:CAIN
Suffix:
Gender:M
Credentials:APRN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5904 SUMMERFIELD DR
Mailing Address - Street 2:
Mailing Address - City:TEXARKANA
Mailing Address - State:TX
Mailing Address - Zip Code:75503-4306
Mailing Address - Country:US
Mailing Address - Phone:430-200-4350
Mailing Address - Fax:866-337-1615
Practice Address - Street 1:5904 SUMMERFIELD DR
Practice Address - Street 2:
Practice Address - City:TEXARKANA
Practice Address - State:TX
Practice Address - Zip Code:75503-4306
Practice Address - Country:US
Practice Address - Phone:430-200-4350
Practice Address - Fax:866-337-1615
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-15
Last Update Date:2023-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP142145363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXAP142145OtherTBON