Provider Demographics
NPI:1275034787
Name:CALDWELL WEBB, STACEY
Entity Type:Individual
Prefix:
First Name:STACEY
Middle Name:
Last Name:CALDWELL WEBB
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 1:19423 LAKE HOLLOW LN
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77084-4865
Mailing Address - Country:US
Mailing Address - Phone:346-304-3094
Mailing Address - Fax:
Practice Address - Street 1:19423 LAKE HOLLOW LN
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77084-4865
Practice Address - Country:US
Practice Address - Phone:346-304-3094
Practice Address - Fax:346-304-3094
Is Sole Proprietor?:No
Enumeration Date:2018-02-21
Last Update Date:2018-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX760283163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX760283OtherREGISTER NURSE
TX760283OtherTEXAS BOARD OF NURSING