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General NPI Number Information
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NPI Number | 1679598791
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Entity Type | Individual
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Provider Name | HEATHER CAUDILL PUCKETT ANP-C
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Gender | Female
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Dates
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Enumeration Date | 07/12/2006
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Last Update Date | 11/11/2021
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Provider Practice Location Address
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Address Line | 200 MEDICAL PARK DR STE 400
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City | CONCORD
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State | NC
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Zip | 28025-0906
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Country | US
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Telephone | 704-786-1108
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Fax | 704-782-1826
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Provider Business Mailing Address
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Address Line | 200 MEDICAL PARK DR STE 400
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City | CONCORD
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State | NC
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Zip | 28025-0906
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Country | US
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Telephone | 704-786-1108
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Fax | 704-782-1826
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | 900455
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License Number State | NC
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