Provider Demographics
NPI:1093139297
Name:CALDWELL, BETTY (RN)
Entity Type:Individual
Prefix:
First Name:BETTY
Middle Name:
Last Name:CALDWELL
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2403 AMMONS ST
Mailing Address - Street 2:
Mailing Address - City:NACOGDOCHES
Mailing Address - State:TX
Mailing Address - Zip Code:75964-3008
Mailing Address - Country:US
Mailing Address - Phone:936-564-8856
Mailing Address - Fax:936-564-8856
Practice Address - Street 1:2403 AMMONS ST
Practice Address - Street 2:
Practice Address - City:NACOGDOCHES
Practice Address - State:TX
Practice Address - Zip Code:75964-3008
Practice Address - Country:US
Practice Address - Phone:936-564-8856
Practice Address - Fax:936-564-8856
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-07
Last Update Date:2014-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX756109163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse