Provider Demographics
NPI:1023503265
Name:KAECHELE, CECILIA (NP)
Entity type:Individual
Prefix:
First Name:CECILIA
Middle Name:
Last Name:KAECHELE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2530
Mailing Address - Street 2:
Mailing Address - City:DAVIDSON
Mailing Address - State:NC
Mailing Address - Zip Code:28036-2530
Mailing Address - Country:US
Mailing Address - Phone:704-997-5525
Mailing Address - Fax:704-997-5531
Practice Address - Street 1:557 BROOKDALE DR
Practice Address - Street 2:
Practice Address - City:STATESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28677
Practice Address - Country:US
Practice Address - Phone:704-997-5525
Practice Address - Fax:704-997-5531
Is Sole Proprietor?:No
Enumeration Date:2018-06-29
Last Update Date:2018-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC219982363LA2200X
NC010669363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health