Provider Demographics
NPI:1467181354
Name:CAFFEY, NICOLLE' RUTH (LMT ART NMT PNF)
Entity Type:Individual
Prefix:
First Name:NICOLLE'
Middle Name:RUTH
Last Name:CAFFEY
Suffix:
Gender:F
Credentials:LMT ART NMT PNF
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6448 HIGH LAWN TER
Mailing Address - Street 2:
Mailing Address - City:WATAUGA
Mailing Address - State:TX
Mailing Address - Zip Code:76148-1415
Mailing Address - Country:US
Mailing Address - Phone:682-808-1611
Mailing Address - Fax:
Practice Address - Street 1:5720 WATAUGA RD
Practice Address - Street 2:
Practice Address - City:WATAUGA
Practice Address - State:TX
Practice Address - Zip Code:76148-3081
Practice Address - Country:US
Practice Address - Phone:682-808-1611
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-07
Last Update Date:2022-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXMT133642225700000X
TX451042-09246ZA2600X
CO451042-09246ZA2600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246ZA2600XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherArt, Medical
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NAOtherNA