Provider Demographics
NPI:1932712395
Name:CALDWELL, ANTHONY DEWAYNE
Entity Type:Individual
Prefix:
First Name:ANTHONY
Middle Name:DEWAYNE
Last Name:CALDWELL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:129 DEER PARK LN
Mailing Address - Street 2:
Mailing Address - City:COOL RIDGE
Mailing Address - State:WV
Mailing Address - Zip Code:25825-1100
Mailing Address - Country:US
Mailing Address - Phone:304-615-4394
Mailing Address - Fax:
Practice Address - Street 1:129 DEER PARK LN
Practice Address - Street 2:
Practice Address - City:COOL RIDGE
Practice Address - State:WV
Practice Address - Zip Code:25825-1100
Practice Address - Country:US
Practice Address - Phone:304-615-4394
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-26
Last Update Date:2020-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide