MEDICARE: MS. PAULETTA DIANNE CAYLOR CRNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	1-074492	AL

General Provider Information

NPI Number	:	1407052749
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. PAULETTA DIANNE CAYLOR CRNP

Provider Business Mailing Address
First Line	:	2903 WALL TRIANA
Second Line	:	SUITE 6
City	:	HUNTSVILLE
State	:	AL
Zip	:	35824
Country	:	US
Telephone Number	:	256-464-9085
Fax Number	:	256-464-9084

Provider Business Practice Location Address
First Line	:	2903 WALL TRIANA HWY SW
Second Line	:	SUITE 6
City	:	HUNTSVILLE
State	:	AL
Zip	:	35824-1537
Country	:	US
Telephone Number	:	255-464-9085
Fax Number	:	256-464-9084

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/25/2007
Last Update Date	:	11/29/2017

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