Healthcare Provider Details

I. General information

NPI: 1881818409
Provider Name (Legal Business Name): NELLIE DAS CAULEY ANP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/13/2007
Last Update Date: 09/02/2025
Certification Date: 09/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

433 COPPERFIELD BLVD NE
CONCORD NC
28025-2405
US

IV. Provider business mailing address

3158 FREEDOM DR STE 3102
CHARLOTTE NC
28208-0014
US

V. Phone/Fax

Practice location:
  • Phone: 704-786-7770
  • Fax: 704-788-9351
Mailing address:
  • Phone: 704-332-0396
  • Fax: 704-971-0035

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number5005932
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberCNP201512
License Number StateME
# 3
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number5005932
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: