Provider Demographics
NPI:1033738323
Name:CALDWELL, EMILY RANDALL (NP)
Entity Type:Individual
Prefix:MRS
First Name:EMILY
Middle Name:RANDALL
Last Name:CALDWELL
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1715 TIMBER DR
Mailing Address - Street 2:
Mailing Address - City:MOORESBORO
Mailing Address - State:NC
Mailing Address - Zip Code:28114-7810
Mailing Address - Country:US
Mailing Address - Phone:828-447-4312
Mailing Address - Fax:
Practice Address - Street 1:322 N PINE ST
Practice Address - Street 2:
Practice Address - City:SPARTANBURG
Practice Address - State:SC
Practice Address - Zip Code:29302-1631
Practice Address - Country:US
Practice Address - Phone:864-582-5099
Practice Address - Fax:864-327-1098
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-16
Last Update Date:2020-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC23786363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner