=====================================================
General NPI Number Information
=====================================================
NPI Number | 1881502813
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CHARDAE WATLEY
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/31/2026
-----------------------------------------------------
Last Update Date | 08/31/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8801 FAST PARK DR
-----------------------------------------------------
City | RALEIGH
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27617-4852
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 919-213-0749
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1439 BAILEY CIR
-----------------------------------------------------
City | HIGH POINT
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27262-3563
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 856-408-0054
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 246RP1900X
-----------------------------------------------------
Taxonomy Name | Phlebotomy Technician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------