Provider Demographics
NPI:1619551322
Name:CAVES, BOB (LPN)
Entity Type:Individual
Prefix:
First Name:BOB
Middle Name:
Last Name:CAVES
Suffix:
Gender:M
Credentials:LPN
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 565
Mailing Address - Street 2:
Mailing Address - City:DEER LODGE
Mailing Address - State:TN
Mailing Address - Zip Code:37726-0565
Mailing Address - Country:US
Mailing Address - Phone:931-704-6489
Mailing Address - Fax:
Practice Address - Street 1:222 RED WING LN
Practice Address - Street 2:
Practice Address - City:DEER LODGE
Practice Address - State:TN
Practice Address - Zip Code:37726-3815
Practice Address - Country:US
Practice Address - Phone:931-704-6489
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-09
Last Update Date:2021-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN91839164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse