Provider Demographics
NPI:1871893206
Name:WINDHAM, CAYLON (FNP)
Entity type:Individual
Prefix:
First Name:CAYLON
Middle Name:
Last Name:WINDHAM
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12805 HIGHWAY 28 EAST
Mailing Address - Street 2:SUITE B
Mailing Address - City:PINEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:71360
Mailing Address - Country:US
Mailing Address - Phone:318-466-5151
Mailing Address - Fax:318-466-3535
Practice Address - Street 1:12805 HIGHWAY 28 E
Practice Address - Street 2:SUITE B
Practice Address - City:PINEVILLE
Practice Address - State:LA
Practice Address - Zip Code:71360-0734
Practice Address - Country:US
Practice Address - Phone:318-466-5151
Practice Address - Fax:318-466-3535
Is Sole Proprietor?:No
Enumeration Date:2010-11-02
Last Update Date:2023-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP06284363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2144901Medicaid