Healthcare Provider Details

I. General information

NPI: 1871893206
Provider Name (Legal Business Name): CAYLON WINDHAM FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/02/2010
Last Update Date: 05/12/2026
Certification Date: 05/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

114 E SOUTHERN AVE STE B
JENA LA
71342-4504
US

IV. Provider business mailing address

114 E SOUTHERN AVE
JENA LA
71342-4504
US

V. Phone/Fax

Practice location:
  • Phone: 318-992-2732
  • Fax: 833-875-0047
Mailing address:
  • Phone: 318-992-2732
  • Fax: 833-875-0047

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAP06284
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: