Provider Demographics
NPI:1902813462
Name:CALDWELL, TRINA GABERT (APRN)
Entity Type:Individual
Prefix:MRS
First Name:TRINA
Middle Name:GABERT
Last Name:CALDWELL
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:MS
Other - First Name:TRINA
Other - Middle Name:DELYNN
Other - Last Name:GABERT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN
Mailing Address - Street 1:2483 I-40 WEST
Mailing Address - Street 2:
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79109
Mailing Address - Country:US
Mailing Address - Phone:806-463-3200
Mailing Address - Fax:806-463-3179
Practice Address - Street 1:2483 I-40 WEST
Practice Address - Street 2:
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79109
Practice Address - Country:US
Practice Address - Phone:806-463-3200
Practice Address - Fax:806-463-3179
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2014-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX527282363L00000X, 363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMP6119Medicaid
TX179452101Medicaid
OK200128470 AMedicaid
TX179452104OtherMEDICAID - INTERNAL MEDICNE
TX8J9935OtherMEDICARE - OB/GYN
TX179452103OtherMEDICAID - OB/GYN
TX8L25326OtherMEDICARE - INTERNAL MEDICINE
TX8L25326OtherMEDICARE - INTERNAL MEDICINE
TX8G4485Medicare PIN
TX179452104OtherMEDICAID - INTERNAL MEDICNE