Caleb Brown
Individual provider Active NPI Psychiatric/Mental Health Registered Nurse · Edwardsville, IL
NPI 1063094530 · NPPES record last updated Apr 24, 2021
Key facts
- NPI
- 1063094530
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Psychiatric/Mental Health Registered Nurse 163WP0808X
- License
- 041465387 (IL)
- Practice address
- 912 N Main St Apt 10
Edwardsville, IL 62025-1161 - Phone
- (217) 460-0033
- NPI assigned
- Apr 24, 2021
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 041465387 | IL | MD | Psychiatric/Mental Health Registered Nurse |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychiatric/Mental Health Registered Nurse | 163WP0808X | 041465387 | IL | Yes |
Addresses
Primary practice location
912 N Main St Apt 10
Edwardsville, IL 62025-1161
Mailing address
912 N Main St Apt 10
Edwardsville, IL 62025-1161
Phone (217) 460-0033
Other providers in Edwardsville, IL
- Harvey Breckner
- Carl David Brickman
- Rebecca Bristow
- Abigail Kirstie Brohammer
- Abbey Brooks
- Miah Brown
- Montana Sky Brown
- Nathan Brown
- Demarco Shontez Brownlee
- Brittany Rachelle Brunetti
All providers in Edwardsville, IL · Psychiatric/Mental Health Registered Nurse in Illinois
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 24, 2021. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.