Healthcare Provider Details

I. General information

NPI: 1518160431
Provider Name (Legal Business Name): SUSAN EDITH CAULKINS MSN, APRN, BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/07/2007
Last Update Date: 11/04/2020
Certification Date: 11/04/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 E HOSPITAL ST STE 3
MANNING SC
29102-3149
US

IV. Provider business mailing address

50 E HOSPITAL ST STE 3
MANNING SC
29102-3149
US

V. Phone/Fax

Practice location:
  • Phone: 803-435-8828
  • Fax: 803-435-2239
Mailing address:
  • Phone: 803-435-8828
  • Fax: 803-435-2239

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number749
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: