Provider Demographics
NPI:1245108968
Name:FEDERSPIEL, CALEB DANIEL (FP-C)
Entity type:Individual
Prefix:
First Name:CALEB
Middle Name:DANIEL
Last Name:FEDERSPIEL
Suffix:
Gender:M
Credentials:FP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1594 COBRA LN
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37042-0706
Mailing Address - Country:US
Mailing Address - Phone:910-494-0775
Mailing Address - Fax:
Practice Address - Street 1:1594 COBRA LN
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37042-0706
Practice Address - Country:US
Practice Address - Phone:910-494-0775
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-10-24
Last Update Date:2025-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1710I1002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman