Healthcare Provider Details

I. General information

NPI: 1689746323
Provider Name (Legal Business Name): KATHERINE CHRISTINE CAGGIANO PHYSICIAN ASSISTANT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/15/2006
Last Update Date: 09/07/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

719 EAST BLVD
CHARLOTTE NC
28203
US

IV. Provider business mailing address

719 EAST BLVD
CHARLOTTE NC
28203-5113
US

V. Phone/Fax

Practice location:
  • Phone: 704-376-9849
  • Fax:
Mailing address:
  • Phone: 704-376-9849
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number001000639
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: