Provider Demographics
NPI:1104692359
Name:CAYLOR, DOUGLAS EARL (RN)
Entity type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:EARL
Last Name:CAYLOR
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:HC 64 BOX 1712
Mailing Address - Street 2:
Mailing Address - City:CASTLE VALLEY
Mailing Address - State:UT
Mailing Address - Zip Code:84532-9609
Mailing Address - Country:US
Mailing Address - Phone:435-259-5388
Mailing Address - Fax:
Practice Address - Street 1:382 W CARE CAMPUS DR
Practice Address - Street 2:
Practice Address - City:MOAB
Practice Address - State:UT
Practice Address - Zip Code:84532-2331
Practice Address - Country:US
Practice Address - Phone:435-719-3988
Practice Address - Fax:435-719-3971
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-29
Last Update Date:2023-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT4897722-3102163WA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WA0400XNursing Service ProvidersRegistered NurseAddiction (Substance Use Disorder)