Healthcare Provider Details

I. General information

NPI: 1053947150
Provider Name (Legal Business Name): CHASTITY CAULDER BENSON FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2020
Last Update Date: 03/22/2021
Certification Date: 03/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2936 N ELM ST STE 102
LUMBERTON NC
28358-2981
US

IV. Provider business mailing address

2002 N CEDAR ST STE B
LUMBERTON NC
28358-3926
US

V. Phone/Fax

Practice location:
  • Phone: 910-671-6619
  • Fax: 910-608-0487
Mailing address:
  • Phone: 910-272-3048
  • Fax: 910-738-3764

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number5013013
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: