Doctor Name: | KEITH CALDWELL |
NPI Number: | 1790959013 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | |
License Number: | TN12552 |
Business Practice Address: | 491 Sage Rd N Suite 200 White House, TN - 371889138 |
Business Phone Number: | 6156727122 |
Business Fax Number: | 6156728122 |
Mailing Address: | 491 Sage Rd N, Suite 200 WHITE HOUSE |
State: | TN |
Postal Code: | 371889138 |
Phone Number: | 6156727122 |
Fax Number: | 6156728122 |
NPI Enumeration Date: | 04/17/2008 |
NPI Last Update Date: | 04/17/2008 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LF0000X |
License Number: | TN12552 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | TN |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Family |
Taxonomy Definition: |