Healthcare Provider Details

I. General information

NPI: 1699693903
Provider Name (Legal Business Name): CHARNETTA CALDWELL LPN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2026
Last Update Date: 07/07/2026
Certification Date: 07/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

310 MURPHY DR
LEXINGTON NC
27295-2100
US

IV. Provider business mailing address

1809 OLIVERS CROSSING CIR
WINSTON SALEM NC
27127-7133
US

V. Phone/Fax

Practice location:
  • Phone: 336-224-1919
  • Fax:
Mailing address:
  • Phone: 336-224-1919
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number86869
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: