Healthcare Provider Details

I. General information

NPI: 1336561471
Provider Name (Legal Business Name): CATHERINE CALDWELL CANALE RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/08/2014
Last Update Date: 12/08/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1487 W KEISER AVE STE I
OSCEOLA AR
72370-2806
US

IV. Provider business mailing address

700 INDIANA ST
BLYTHEVILLE AR
72315-1408
US

V. Phone/Fax

Practice location:
  • Phone: 870-563-4500
  • Fax: 870-563-4501
Mailing address:
  • Phone: 901-647-2567
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0807X
TaxonomyChild & Adolescent Psychiatric/Mental Health Registered Nurse
License NumberR095058
License Number StateAR
# 2
Primary TaxonomyN
Taxonomy Code163WP0807X
TaxonomyChild & Adolescent Psychiatric/Mental Health Registered Nurse
License NumberRTP-013866
License Number StateAR
# 3
Primary TaxonomyN
Taxonomy Code163WP0807X
TaxonomyChild & Adolescent Psychiatric/Mental Health Registered Nurse
License NumberRN0000065843
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: