Provider Demographics
NPI:1548784945
Name:CALDWELL, OPAL LOUISE (FNP)
Entity Type:Individual
Prefix:
First Name:OPAL
Middle Name:LOUISE
Last Name:CALDWELL
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:OPAL
Other - Middle Name:LOUISE
Other - Last Name:SWANSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:705 N HIGH ST
Mailing Address - Street 2:
Mailing Address - City:MORRISTOWN
Mailing Address - State:TN
Mailing Address - Zip Code:37814-3876
Mailing Address - Country:US
Mailing Address - Phone:423-415-3310
Mailing Address - Fax:423-587-9898
Practice Address - Street 1:705 N HIGH ST
Practice Address - Street 2:
Practice Address - City:MORRISTOWN
Practice Address - State:TN
Practice Address - Zip Code:37814-3876
Practice Address - Country:US
Practice Address - Phone:423-415-3310
Practice Address - Fax:423-587-9898
Is Sole Proprietor?:No
Enumeration Date:2017-07-28
Last Update Date:2020-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN22887363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner