Provider Demographics
NPI:1538330485
Name:RAE, CALEB SLOAN (PA)
Entity Type:Individual
Prefix:
First Name:CALEB
Middle Name:SLOAN
Last Name:RAE
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 70
Mailing Address - Street 2:
Mailing Address - City:PALMER
Mailing Address - State:TN
Mailing Address - Zip Code:37365-0000
Mailing Address - Country:US
Mailing Address - Phone:931-779-4002
Mailing Address - Fax:931-779-4003
Practice Address - Street 1:126 POLK STREET
Practice Address - Street 2:
Practice Address - City:BENTON
Practice Address - State:TN
Practice Address - Zip Code:37307
Practice Address - Country:US
Practice Address - Phone:423-338-8995
Practice Address - Fax:423-338-8996
Is Sole Proprietor?:No
Enumeration Date:2008-03-19
Last Update Date:2008-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNPA1558363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant