Provider Demographics
NPI:1790042406
Name:CALKINS, RICHARD DEAN (FNP)
Entity Type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:DEAN
Last Name:CALKINS
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2401 WALKER PLACE BLVD
Mailing Address - Street 2:# 300
Mailing Address - City:COPPERAS COVE
Mailing Address - State:TX
Mailing Address - Zip Code:76522-4025
Mailing Address - Country:US
Mailing Address - Phone:254-547-5516
Mailing Address - Fax:
Practice Address - Street 1:2401 WALKER PLACE BLVD
Practice Address - Street 2:# 300
Practice Address - City:COPPERAS COVE
Practice Address - State:TX
Practice Address - Zip Code:76522-4025
Practice Address - Country:US
Practice Address - Phone:254-547-5516
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-04-19
Last Update Date:2020-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX642379363LF0000X
TXAP121754363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily