Provider Demographics
NPI:1003990458
Name:ADAMS, CAROLINE (NP)
Entity Type:Individual
Prefix:
First Name:CAROLINE
Middle Name:
Last Name:ADAMS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 19305
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28219-9305
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:340 JAKE ALEXANDER BLVD W
Practice Address - Street 2:
Practice Address - City:SALISBURY
Practice Address - State:NC
Practice Address - Zip Code:28147-1364
Practice Address - Country:US
Practice Address - Phone:704-403-6260
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-24
Last Update Date:2021-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC600046363L00000X
NC93455363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1003990458Medicaid
NC89014CEMedicaid
NCMOA342953OtherDEA #
NC600046OtherNC LICENSE #
NC1033196837OtherPRACTICE NPI
NC2591078BMedicare PIN
NC2591078Medicare PIN
NCMOA342953OtherDEA #
NC1003990458Medicaid
NC500030015Medicare PIN
NC2591078CMedicare PIN