Healthcare Provider Details

I. General information

NPI: 1871396184
Provider Name (Legal Business Name): DAUGETTE CAULKER NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/31/2025
Last Update Date: 03/31/2025
Certification Date: 03/31/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3734 MECHANICSVILLE PL
PHILADELPHIA PA
19154-2011
US

IV. Provider business mailing address

3734 MECHANICSVILLE PL
PHILADELPHIA PA
19154-2011
US

V. Phone/Fax

Practice location:
  • Phone: 919-884-1583
  • Fax:
Mailing address:
  • Phone: 919-884-1583
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License NumberSP030265
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: