Provider Demographics
NPI:1760146476
Name:CALDWELL, KYLEY JENNIFER
Entity Type:Individual
Prefix:
First Name:KYLEY
Middle Name:JENNIFER
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 1:1125 CARTHAGE ST
Mailing Address - Street 2:
Mailing Address - City:SANFORD
Mailing Address - State:NC
Mailing Address - Zip Code:27330-4162
Mailing Address - Country:US
Mailing Address - Phone:910-774-6023
Mailing Address - Fax:
Practice Address - Street 1:101 CHURCH ST
Practice Address - Street 2:
Practice Address - City:BROADWAY
Practice Address - State:NC
Practice Address - Zip Code:27505-9394
Practice Address - Country:US
Practice Address - Phone:919-258-6521
Practice Address - Fax:919-258-5368
Is Sole Proprietor?:No
Enumeration Date:2021-10-28
Last Update Date:2023-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5015281363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily