Healthcare Provider Details

I. General information

NPI: 1386565596
Provider Name (Legal Business Name): STACY LYNN CALDWELL FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/23/2026
Last Update Date: 07/23/2026
Certification Date: 07/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2112 W DAVIS ST
CONROE TX
77304-2049
US

IV. Provider business mailing address

16840 FALCON SOUND DR
MONTGOMERY TX
77356-8386
US

V. Phone/Fax

Practice location:
  • Phone: 512-922-4947
  • Fax:
Mailing address:
  • Phone: 512-922-4947
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number1239694
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: