Healthcare Provider Details

I. General information

NPI: 1336410703
Provider Name (Legal Business Name): RICHARD LAMAR CAIN NP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: RICHARD CAIN PMNHP-BC

II. Dates (important events)

Enumeration Date: 01/18/2012
Last Update Date: 10/19/2021
Certification Date: 10/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3512 STELLHORN RD
FORT WAYNE IN
46815-4631
US

IV. Provider business mailing address

250 N SHADELAND AVE
INDIANAPOLIS IN
46219-4959
US

V. Phone/Fax

Practice location:
  • Phone: 260-483-9081
  • Fax: 260-483-9196
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License Number28173909A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number71004523B
License Number StateIN
# 3
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number71004523A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: