Provider Demographics
NPI:1831269091
Name:CASSELL, CHARLOTTE WATSON (FNP)
Entity type:Individual
Prefix:MRS
First Name:CHARLOTTE
Middle Name:WATSON
Last Name:CASSELL
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1006 OLD ROCKFORD ST
Mailing Address - Street 2:
Mailing Address - City:MOUNT AIRY
Mailing Address - State:NC
Mailing Address - Zip Code:27030-5361
Mailing Address - Country:US
Mailing Address - Phone:336-719-0400
Mailing Address - Fax:336-648-8648
Practice Address - Street 1:1006 OLD ROCKFORD ST
Practice Address - Street 2:
Practice Address - City:MOUNT AIRY
Practice Address - State:NC
Practice Address - Zip Code:27030-5361
Practice Address - Country:US
Practice Address - Phone:336-719-0400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-08
Last Update Date:2025-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200530363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
66914OtherMEDCOST
NC7000685Medicaid
66914OtherMEDCOST