Provider Demographics
NPI:1821440116
Name:CALDWELL, KANISHER (APRN)
Entity Type:Individual
Prefix:
First Name:KANISHER
Middle Name:
Last Name:CALDWELL
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7500 DOLLARWAY RD STE 403
Mailing Address - Street 2:
Mailing Address - City:WHITE HALL
Mailing Address - State:AR
Mailing Address - Zip Code:71602-3083
Mailing Address - Country:US
Mailing Address - Phone:870-247-4525
Mailing Address - Fax:870-247-4294
Practice Address - Street 1:7500 DOLLARWAY RD STE 403
Practice Address - Street 2:
Practice Address - City:WHITE HALL
Practice Address - State:AR
Practice Address - Zip Code:71602-3083
Practice Address - Country:US
Practice Address - Phone:870-247-4525
Practice Address - Fax:870-247-4294
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-11
Last Update Date:2022-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA004742363LG0600X, 363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology