Healthcare Provider Details

I. General information

NPI: 1700720927
Provider Name (Legal Business Name): CANDICE CASTLEBERRY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/17/2026
Last Update Date: 04/17/2026
Certification Date: 04/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3429 HICKORY HAVEN LN
WILLOW SPRING NC
27592-9662
US

IV. Provider business mailing address

3429 HICKORY HAVEN LN
WILLOW SPRING NC
27592-9662
US

V. Phone/Fax

Practice location:
  • Phone: 919-917-3895
  • Fax:
Mailing address:
  • Phone: 919-917-3895
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number492957
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: