Healthcare Provider Details

I. General information

NPI: 1477297158
Provider Name (Legal Business Name): EDGAR ENRIQUE CALITO FNP-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/27/2022
Last Update Date: 09/17/2026
Certification Date: 09/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

BRIAN D. ALLGOOD ARMY COMMUNITY HOSPITAL (BDAACH) UNIT # 15245 BUILDING 3031, CAMP HUMPHREYS
APO AP
96271
US

IV. Provider business mailing address

PSC 444 BOX 2245
APO AP
96297-0023
US

V. Phone/Fax

Practice location:
  • Phone: 315-737-1411
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1020487
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: