Provider Demographics
NPI:1457993065
Name:DEIKE, CALEB SHEA (MSN, APRN, FNP-C)
Entity Type:Individual
Prefix:MR
First Name:CALEB
Middle Name:SHEA
Last Name:DEIKE
Suffix:
Gender:M
Credentials:MSN, APRN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1930 US HIGHWAY 190 W
Mailing Address - Street 2:
Mailing Address - City:LIVINGSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77351-9600
Mailing Address - Country:US
Mailing Address - Phone:936-327-9944
Mailing Address - Fax:936-327-9945
Practice Address - Street 1:1930 US HIGHWAY 190 W
Practice Address - Street 2:
Practice Address - City:LIVINGSTON
Practice Address - State:TX
Practice Address - Zip Code:77351-9600
Practice Address - Country:US
Practice Address - Phone:936-327-9944
Practice Address - Fax:936-327-9945
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-15
Last Update Date:2019-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP143502363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily