Provider Demographics
NPI:1306645734
Name:CARAWAY, ADDISON
Entity type:Individual
Prefix:
First Name:ADDISON
Middle Name:
Last Name:CARAWAY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ADDISON
Other - Middle Name:
Other - Last Name:VAUGIER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 776084
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60677-6084
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1723 BROADWAY ST STE 310
Practice Address - Street 2:
Practice Address - City:CAPE GIRARDEAU
Practice Address - State:MO
Practice Address - Zip Code:63701-4556
Practice Address - Country:US
Practice Address - Phone:573-519-4540
Practice Address - Fax:573-519-4541
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-10
Last Update Date:2025-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant