Provider Demographics
NPI:1760022370
Name:CALDWELL, HALEY NICHOLE
Entity Type:Individual
Prefix:
First Name:HALEY
Middle Name:NICHOLE
Last Name:CALDWELL
Suffix:
Gender:F
Credentials:
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 142
Mailing Address - Street 2:
Mailing Address - City:GRANDY
Mailing Address - State:NC
Mailing Address - Zip Code:27939-0142
Mailing Address - Country:US
Mailing Address - Phone:252-305-5759
Mailing Address - Fax:
Practice Address - Street 1:195 WESTSIDE DR APT 304C
Practice Address - Street 2:
Practice Address - City:CULLOWHEE
Practice Address - State:NC
Practice Address - Zip Code:28723-1247
Practice Address - Country:US
Practice Address - Phone:252-305-5759
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-11
Last Update Date:2020-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer