Healthcare Provider Details

I. General information

NPI: 1801776976
Provider Name (Legal Business Name): LONNY RAY CAUGHRON
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/08/2025
Last Update Date: 09/08/2025
Certification Date: 09/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10024 MANOR WAY
FORNEY TX
75126-5657
US

IV. Provider business mailing address

10024 MANOR WAY
FORNEY TX
75126-5657
US

V. Phone/Fax

Practice location:
  • Phone: 469-323-1919
  • Fax:
Mailing address:
  • Phone: 469-323-1919
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WE0003X
TaxonomyEmergency Registered Nurse
License Number731744
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: