Basic Information
| Provider Information | |||||||||
| NPI: | 1891172342 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CAGLE | ||||||||
| FirstName: | DEIDRE | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | RN | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | LEE | ||||||||
| OtherFirstName: | DEIDRE | ||||||||
| OtherMiddleName: | D | ||||||||
| OtherNamePrefix: | |||||||||
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| OtherCredential: | |||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 1316 SOMERVILLE RD SE | ||||||||
| Address2: | SUITE 1 | ||||||||
| City: | DECATUR | ||||||||
| State: | AL | ||||||||
| PostalCode: | 356014305 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2562607361 | ||||||||
| FaxNumber: | 2563410747 | ||||||||
| Practice Location | |||||||||
| Address1: | 4110 US HIGHWAY 31 S | ||||||||
| Address2: | |||||||||
| City: | DECATUR | ||||||||
| State: | AL | ||||||||
| PostalCode: | 356031644 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2562607361 | ||||||||
| FaxNumber: | 2563410747 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/05/2015 | ||||||||
| LastUpdateDate: | 05/05/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163WP0808X | 1-120185 | AL | Y | Nursing Service Providers | Registered Nurse | Psych/Mental Health |
No ID Information.