Individual
SHANA KAY CALDWELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RN, MSN, CPNP
Contact information
Practice address
305 W RUSK ST, TYLER, TX 75701-1514
(903) 592-7304
(903) 592-1288
Mailing address
PO BOX 846098, DALLAS, TX 75284-6098
(903) 324-6450
Taxonomy
Speciality
Code
Description
License number
State
363LP0200X
Pediatric Nurse Practitioner
Primary
687871
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
186970302
—
TX
05
—
186970303
—
TX
Enumeration date
12/12/2006
Last updated
06/05/2015
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