Healthcare Provider Details

I. General information

NPI: 1922129154
Provider Name (Legal Business Name): ANGELA LEE CALLICUTT RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/03/2007
Last Update Date: 10/23/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 PARKER LN SUITE 1
PINEHURST NC
28374-7903
US

IV. Provider business mailing address

129 ALDER BRANCH DRIVE PO BOX 1075
BISCOE NC
27209-1075
US

V. Phone/Fax

Practice location:
  • Phone: 910-295-3133
  • Fax: 910-295-2723
Mailing address:
  • Phone: 910-428-5296
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License Number127266
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: