Healthcare Provider Details

I. General information

NPI: 1922693605
Provider Name (Legal Business Name): EDISA GRIFFIN CALDWELL FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/04/2021
Last Update Date: 07/12/2023
Certification Date: 07/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

145 W PARKER RD STE C
MORGANTON NC
28655-4649
US

IV. Provider business mailing address

145 W PARKER RD STE C
MORGANTON NC
28655-4628
US

V. Phone/Fax

Practice location:
  • Phone: 828-608-0500
  • Fax:
Mailing address:
  • Phone: 828-608-0500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number5014168
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: