Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363LF0000X | Nurse Practitioner - Family Medicine | 903693 | MS |
Y | 363LP2300X | Nurse Practitioner - Primary Care | 903693 | MS |
NPI | 1073151684 |
---|---|
Provider Name | Robyn Black Caldwell |
First Address | Senatobia, MS 38668-4083 |
Second Address | Holly Springs, MS 38635 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/12/2019 |
Last Update Date | 13/12/2019 |