Provider Demographics
NPI:1194809657
Name:CALDWELL, BENJAMIN CLAY (C-FNP)
Entity type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:CLAY
Last Name:CALDWELL
Suffix:
Gender:M
Credentials:C-FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2418 W MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:GUN BARREL CITY
Mailing Address - State:TX
Mailing Address - Zip Code:75156
Mailing Address - Country:US
Mailing Address - Phone:903-173-2000
Mailing Address - Fax:903-713-2004
Practice Address - Street 1:2418 W MAIN ST
Practice Address - Street 2:
Practice Address - City:GUN BARREL CITY
Practice Address - State:TX
Practice Address - Zip Code:75156-3638
Practice Address - Country:US
Practice Address - Phone:903-173-2000
Practice Address - Fax:903-713-2004
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-24
Last Update Date:2014-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX636969261Q00000X, 364SF0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SF0001XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistFamily Health
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center