Provider Demographics
NPI:1801126495
Name:CAINE, CODI (CPNP)
Entity type:Individual
Prefix:
First Name:CODI
Middle Name:
Last Name:CAINE
Suffix:
Gender:F
Credentials:CPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:881 PROFESSIONAL PARK DRIVE
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37040
Mailing Address - Country:US
Mailing Address - Phone:931-645-4685
Mailing Address - Fax:931-245-2117
Practice Address - Street 1:881 PROFESSIONAL PARK DRIVE
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37040
Practice Address - Country:US
Practice Address - Phone:931-645-4685
Practice Address - Fax:931-245-2117
Is Sole Proprietor?:No
Enumeration Date:2010-01-05
Last Update Date:2010-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209.007946363LP0200X
TNAPN0000014485363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics