MEDICARE: OPAL LOUISE CALDWELL FNP

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	363L00000X	Nurse Practitioner	22887	TN

General Provider Information

NPI Number	:	1548784945
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	OPAL LOUISE CALDWELL FNP

Provider Business Mailing Address
First Line	:	705 N HIGH ST
Second Line	:
City	:	MORRISTOWN
State	:	TN
Zip	:	37814-3876
Country	:	US
Telephone Number	:	423-415-3310
Fax Number	:	423-587-9898

Provider Business Practice Location Address
First Line	:	705 N HIGH ST
Second Line	:
City	:	MORRISTOWN
State	:	TN
Zip	:	37814-3876
Country	:	US
Telephone Number	:	423-415-3310
Fax Number	:	423-587-9898

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

Provider Enumeration Date	:	07/28/2017
Last Update Date	:	09/01/2020

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