Healthcare Provider Details

I. General information

NPI: 1114848561
Provider Name (Legal Business Name): AUDRIANNA CARLYLE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/22/2026
Last Update Date: 07/22/2026
Certification Date: 07/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12 BUNK DR LOT 82
LUMBERTON NC
28360-8010
US

IV. Provider business mailing address

12 BUNK DR LOT 82
LUMBERTON NC
28360-8010
US

V. Phone/Fax

Practice location:
  • Phone: 910-633-8997
  • Fax:
Mailing address:
  • Phone: 910-633-8997
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374J00000X
TaxonomyDoula
License Number
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: