Provider Demographics
NPI:1396990628
Name:CALLICOAT, DONNA KAY (NP)
Entity type:Individual
Prefix:MRS
First Name:DONNA
Middle Name:KAY
Last Name:CALLICOAT
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:DONNA
Other - Middle Name:KAY
Other - Last Name:BUTLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:PO BOX 962
Mailing Address - Street 2:
Mailing Address - City:PARIS
Mailing Address - State:TX
Mailing Address - Zip Code:75461-0962
Mailing Address - Country:US
Mailing Address - Phone:903-785-4600
Mailing Address - Fax:903-782-9150
Practice Address - Street 1:4311 WESLEY ST
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:TX
Practice Address - Zip Code:75401-5639
Practice Address - Country:US
Practice Address - Phone:903-455-5986
Practice Address - Fax:903-454-4621
Is Sole Proprietor?:No
Enumeration Date:2008-12-01
Last Update Date:2013-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX610833363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8F21309Medicare PIN