Basic Information
| Provider Information | |||||||||
| NPI: | 1437749488 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CALDWELL | ||||||||
| FirstName: | DEBRA | ||||||||
| MiddleName: | MULLOY | ||||||||
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| Mailing Information | |||||||||
| Address1: | 929 HILLTOP DR | ||||||||
| Address2: | |||||||||
| City: | WEATHERFORD | ||||||||
| State: | TX | ||||||||
| PostalCode: | 760865845 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8173417670 | ||||||||
| FaxNumber: | 8173417678 | ||||||||
| Practice Location | |||||||||
| Address1: | 5225 S LOOP 289 STE 200 | ||||||||
| Address2: | |||||||||
| City: | LUBBOCK | ||||||||
| State: | TX | ||||||||
| PostalCode: | 794241319 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8067804180 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/24/2021 | ||||||||
| LastUpdateDate: | 03/23/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/23/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | F01210672 | TX | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.