Healthcare Provider Details

I. General information

NPI: 1780589937
Provider Name (Legal Business Name): CAYLEE HEAVEN DEE WARD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/08/2026
Last Update Date: 10/08/2026
Certification Date: 10/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

854 W JAMES CAMPBELL BLVD 102
COLUMBIA TN
38401
US

IV. Provider business mailing address

510 MCMEEN CIR
COLUMBIA TN
38401-2089
US

V. Phone/Fax

Practice location:
  • Phone: 805-660-5363
  • Fax:
Mailing address:
  • Phone: 805-660-5363
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License Number84054
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: