Provider Demographics
NPI:1386883007
Name:CALLICOAT FAMILY CLINIC
Entity type:Organization
Organization Name:CALLICOAT FAMILY CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NP
Authorized Official - Prefix:MRS
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:KAY
Authorized Official - Last Name:CALLICOAT
Authorized Official - Suffix:
Authorized Official - Credentials:RN, MSN, FNP-C
Authorized Official - Phone:903-737-8095
Mailing Address - Street 1:11135 FARM ROAD 1497
Mailing Address - Street 2:
Mailing Address - City:PARIS
Mailing Address - State:TX
Mailing Address - Zip Code:75462-3890
Mailing Address - Country:US
Mailing Address - Phone:903-737-8095
Mailing Address - Fax:
Practice Address - Street 1:1025 DESHONG DR
Practice Address - Street 2:
Practice Address - City:PARIS
Practice Address - State:TX
Practice Address - Zip Code:75460-9330
Practice Address - Country:US
Practice Address - Phone:903-785-4600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-19
Last Update Date:2010-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ1535173000000X
TX610833363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
No173000000XOther Service ProvidersLegal MedicineGroup - Single Specialty