Provider Demographics
NPI:1780220921
Name:CAULDER, KRISTEN M (APRN)
Entity Type:Individual
Prefix:
First Name:KRISTEN
Middle Name:M
Last Name:CAULDER
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:SC HOUSE CALLS INC
Mailing Address - Street 2:111 DOCTORS CIRCLE
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29203
Mailing Address - Country:US
Mailing Address - Phone:800-491-0909
Mailing Address - Fax:803-245-6274
Practice Address - Street 1:SC HOUSE CALLS INC
Practice Address - Street 2:111 DOCTORS CIRCLE
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29203
Practice Address - Country:US
Practice Address - Phone:800-491-0909
Practice Address - Fax:803-245-6274
Is Sole Proprietor?:No
Enumeration Date:2019-11-22
Last Update Date:2023-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC23422207Q00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC23422OtherMEDICAL LICENSE
SCSCG912OtherMEDICARE
SCNP6495Medicaid