Provider Demographics
NPI:1437030103
Name:CALDWELL, DORENE (MSN, PMHNP-BC)
Entity type:Individual
Prefix:
First Name:DORENE
Middle Name:
Last Name:CALDWELL
Suffix:
Gender:F
Credentials:MSN, PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4801 E INDEPENDENCE BLVD STE 501
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28212-5494
Mailing Address - Country:US
Mailing Address - Phone:704-388-6736
Mailing Address - Fax:949-695-3608
Practice Address - Street 1:4801 E INDEPENDENCE BLVD STE 501
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28212-5494
Practice Address - Country:US
Practice Address - Phone:704-388-6736
Practice Address - Fax:949-695-3608
Is Sole Proprietor?:Yes
Enumeration Date:2025-09-10
Last Update Date:2025-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5022949363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty