Provider Demographics
NPI:1881818409
Name:CAULEY, NELLIE DAS (ANP)
Entity type:Individual
Prefix:
First Name:NELLIE
Middle Name:DAS
Last Name:CAULEY
Suffix:
Gender:F
Credentials:ANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3158 FREEDOM DR STE 3102
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28208-0014
Mailing Address - Country:US
Mailing Address - Phone:704-332-0396
Mailing Address - Fax:704-971-0035
Practice Address - Street 1:433 COPPERFIELD BLVD NE
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NC
Practice Address - Zip Code:28025-2405
Practice Address - Country:US
Practice Address - Phone:704-786-7770
Practice Address - Fax:704-788-9351
Is Sole Proprietor?:No
Enumeration Date:2007-04-13
Last Update Date:2025-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5005932363LA2200X, 363L00000X
MECNP201512363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7006394Medicaid
NCNC9460AMedicare PIN
TX8D9369Medicare PIN
TXQ51248Medicare UPIN
TX8D9218Medicare PIN
TX206321601Medicaid
TX206321602Medicaid