Provider Demographics
NPI:1295183200
Name:CASTANEDA, ERNEST (FNP)
Entity Type:Individual
Prefix:
First Name:ERNEST
Middle Name:
Last Name:CASTANEDA
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 E CAESAR AVE
Mailing Address - Street 2:
Mailing Address - City:KINGSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78363-6322
Mailing Address - Country:US
Mailing Address - Phone:361-516-0800
Mailing Address - Fax:
Practice Address - Street 1:907 E FORDYCE AVE
Practice Address - Street 2:
Practice Address - City:KINGSVILLE
Practice Address - State:TX
Practice Address - Zip Code:78363-5817
Practice Address - Country:US
Practice Address - Phone:361-221-2461
Practice Address - Fax:361-221-2710
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-31
Last Update Date:2018-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP131055363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily