Provider Demographics
NPI:1144938218
Name:SIDWELL, CAROLINE ANNE (PA-C)
Entity type:Individual
Prefix:
First Name:CAROLINE
Middle Name:ANNE
Last Name:SIDWELL
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:CAROLINE
Other - Middle Name:ANNE
Other - Last Name:WEICKEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:4601 PARK RD STE 300
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28209-2290
Mailing Address - Country:US
Mailing Address - Phone:704-323-2445
Mailing Address - Fax:704-945-7681
Practice Address - Street 1:354 COPPERFIELD BLVD NE
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NC
Practice Address - Zip Code:28025-2402
Practice Address - Country:US
Practice Address - Phone:704-262-4180
Practice Address - Fax:704-782-8279
Is Sole Proprietor?:No
Enumeration Date:2022-11-08
Last Update Date:2024-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9116701363A00000X
NC0010-14137363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant