Healthcare Provider Details

I. General information

NPI: 1417826017
Provider Name (Legal Business Name): JUDITH CADWALLADER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/03/2025
Last Update Date: 11/03/2025
Certification Date: 11/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2050 LEXINGTON RD
VERSAILLES KY
40383-1738
US

IV. Provider business mailing address

7724 ORCHARD PARK CIR
HARRISBURG NC
28075-8725
US

V. Phone/Fax

Practice location:
  • Phone: 704-277-0901
  • Fax:
Mailing address:
  • Phone: 704-277-0901
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: