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General NPI Number Information
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NPI Number | 1386883007
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Entity Type | Organization
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Legal Business Name | CALLICOAT FAMILY CLINIC
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Dates
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Enumeration Date | 02/19/2009
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Last Update Date | 12/21/2010
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Provider Practice Location Address
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Address Line | 1025 DESHONG DR
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City | PARIS
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State | TX
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Zip | 75460-9330
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Country | US
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Telephone | 903-785-4600
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Fax |
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Provider Business Mailing Address
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Address Line | 11135 FARM ROAD 1497
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City | PARIS
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State | TX
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Zip | 75462-3890
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Country | US
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Telephone | 903-737-8095
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Fax |
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Authorized Official
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Title or Position | NP
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Name | MRS. DONNA KAY CALLICOAT
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Credential | RN, MSN, FNP-C
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Telephone | 903-737-8095
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 173000000X
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Taxonomy Name | Legal Medicine
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License Number | J1535
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 610833
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License Number State | TX
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