Provider Demographics
NPI:1598220238
Name:CACERES, JAIME JAMES (NP-C)
Entity Type:Individual
Prefix:MR
First Name:JAIME
Middle Name:JAMES
Last Name:CACERES
Suffix:
Gender:M
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:801 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:GUN BARREL CITY
Mailing Address - State:TX
Mailing Address - Zip Code:75156-5312
Mailing Address - Country:US
Mailing Address - Phone:469-800-3800
Mailing Address - Fax:469-800-3810
Practice Address - Street 1:801 W MAIN ST
Practice Address - Street 2:
Practice Address - City:GUN BARREL CITY
Practice Address - State:TX
Practice Address - Zip Code:75156-5312
Practice Address - Country:US
Practice Address - Phone:469-800-3800
Practice Address - Fax:469-800-3810
Is Sole Proprietor?:No
Enumeration Date:2019-02-06
Last Update Date:2019-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP141034363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily