=====================================================
General NPI Number Information
=====================================================
NPI Number | 1194535104
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ANNA CAUDILL
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/10/2025
-----------------------------------------------------
Last Update Date | 09/04/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 932 MORREENE RD
-----------------------------------------------------
City | DURHAM
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27705-4410
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 919-668-2879
-----------------------------------------------------
Fax | 919-668-2855
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 38 BRAGG LN
-----------------------------------------------------
City | HURDLE MILLS
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27541-7362
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 434-238-8428
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363L00000X
-----------------------------------------------------
Taxonomy Name | Nurse Practitioner
-----------------------------------------------------
License Number | 5022241
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------