MEDICARE: MR. JOE DON CAVENDER RN, CPNP

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	363LP0200X	Pediatric Nurse Practitioner	581820	TX

General Provider Information

NPI Number	:	1851392609
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JOE DON CAVENDER RN, CPNP

Provider Business Mailing Address
First Line	:	1935 MEDICAL DISTRICT DR
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75235-7701
Country	:	US
Telephone Number	:	214-456-2801
Fax Number	:	214-456-2897

Provider Business Practice Location Address
First Line	:	1935 MEDICAL DISTRICT DR
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75235-7701
Country	:	US
Telephone Number	:	214-456-2801
Fax Number	:	214-456-2897

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

Provider Enumeration Date	:	08/02/2005
Last Update Date	:	07/29/2008

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