MEDICARE: DORENE CALDWELL MSN, PMHNP-BC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	5022949	NC

General Provider Information

NPI Number	:	1437030103
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DORENE CALDWELL MSN, PMHNP-BC

Provider Business Mailing Address
First Line	:	4801 E INDEPENDENCE BLVD STE 501
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28212-5494
Country	:	US
Telephone Number	:	704-388-6736
Fax Number	:	949-695-3608

Provider Business Practice Location Address
First Line	:	4801 E INDEPENDENCE BLVD STE 501
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28212-5494
Country	:	US
Telephone Number	:	704-388-6736
Fax Number	:	949-695-3608

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/10/2025
Last Update Date	:	11/21/2025

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