Provider Demographics
NPI:1619312014
Name:CAIN, JANE ASHLEY (MED DIAGNOSTICIAN)
Entity Type:Individual
Prefix:
First Name:JANE
Middle Name:ASHLEY
Last Name:CAIN
Suffix:
Gender:F
Credentials:MED DIAGNOSTICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 DESTA DR
Mailing Address - Street 2:SUITE 184-W
Mailing Address - City:MIDLAND
Mailing Address - State:TX
Mailing Address - Zip Code:79705-4515
Mailing Address - Country:US
Mailing Address - Phone:432-894-0771
Mailing Address - Fax:
Practice Address - Street 1:10 DESTA DR
Practice Address - Street 2:SUITE 184-W
Practice Address - City:MIDLAND
Practice Address - State:TX
Practice Address - Zip Code:79705-4515
Practice Address - Country:US
Practice Address - Phone:432-894-0771
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-04-30
Last Update Date:2013-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXTEA103TM1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TM1800XBehavioral Health & Social Service ProvidersPsychologistIntellectual & Developmental Disabilities