Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2200X | Nurse Practitioner - Adult Health | AP138729 | TX |
N | 363LG0600X | Nurse Practitioner - Gerontology | AP138729 | TX |
N | 363LP0808X | Nurse Practitioner - Psychiatric/Mental Health | AP138729 | TX |
NPI | 1043785744 |
---|---|
Provider Name | Mrs. Brooke Marron Caldwell |
First Address | Dallas, TX 75231-3437 |
Second Address | Dallas, TX 75231-3437 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/10/2018 |
Last Update Date | 25/07/2021 |