Healthcare Provider Details

I. General information

NPI: 1194453829
Provider Name (Legal Business Name): SHERRI DIANE CAUDILL FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/10/2022
Last Update Date: 04/02/2024
Certification Date: 04/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4102 22ND PL
LUBBOCK TX
79410-1122
US

IV. Provider business mailing address

5529 50TH ST APT 1806
LUBBOCK TX
79414-1657
US

V. Phone/Fax

Practice location:
  • Phone: 806-725-0237
  • Fax: 806-725-1030
Mailing address:
  • Phone: 806-642-3442
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1088566
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: