Healthcare Provider Details

I. General information

NPI: 1194535104
Provider Name (Legal Business Name): ANNA CAUDILL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/10/2025
Last Update Date: 09/04/2025
Certification Date: 09/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

932 MORREENE RD
DURHAM NC
27705-4410
US

IV. Provider business mailing address

38 BRAGG LN
HURDLE MILLS NC
27541-7362
US

V. Phone/Fax

Practice location:
  • Phone: 919-668-2879
  • Fax: 919-668-2855
Mailing address:
  • Phone: 434-238-8428
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number5022241
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: