Provider Demographics
NPI:1386630333
Name:CAUDELL, HEATHER LYNN (RN, CNM)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:LYNN
Last Name:CAUDELL
Suffix:
Gender:F
Credentials:RN, CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:328 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:LEWISVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75057-3866
Mailing Address - Country:US
Mailing Address - Phone:972-436-7557
Mailing Address - Fax:972-221-8246
Practice Address - Street 1:328 W MAIN ST
Practice Address - Street 2:
Practice Address - City:LEWISVILLE
Practice Address - State:TX
Practice Address - Zip Code:75057-3866
Practice Address - Country:US
Practice Address - Phone:972-436-7557
Practice Address - Fax:972-221-8246
Is Sole Proprietor?:No
Enumeration Date:2005-09-26
Last Update Date:2024-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX178167601Medicaid