Provider Demographics
NPI:1427166511
Name:CADDELL, NORMA JEAN (RN, FNP)
Entity type:Individual
Prefix:MS
First Name:NORMA
Middle Name:JEAN
Last Name:CADDELL
Suffix:
Gender:F
Credentials:RN, FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:403 CARNATION DR
Mailing Address - Street 2:
Mailing Address - City:WAXAHACHIE
Mailing Address - State:TX
Mailing Address - Zip Code:75165-1795
Mailing Address - Country:US
Mailing Address - Phone:972-923-2916
Mailing Address - Fax:
Practice Address - Street 1:505 N HIGHWAY 77
Practice Address - Street 2:SUITE 200
Practice Address - City:WAXAHACHIE
Practice Address - State:TX
Practice Address - Zip Code:75165-1128
Practice Address - Country:US
Practice Address - Phone:972-923-1686
Practice Address - Fax:972-937-7731
Is Sole Proprietor?:No
Enumeration Date:2006-08-28
Last Update Date:2013-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX515626363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXCA086N894Medicare ID - Type Unspecified
TX272134YNJCMedicare PIN