Provider Demographics
NPI:1558608455
Name:MCCAULLEY, HEIDI BROOKS (RN)
Entity type:Individual
Prefix:MRS
First Name:HEIDI
Middle Name:BROOKS
Last Name:MCCAULLEY
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:458 RIVERSIDE ST
Mailing Address - Street 2:
Mailing Address - City:PENDLETON
Mailing Address - State:SC
Mailing Address - Zip Code:29670-1211
Mailing Address - Country:US
Mailing Address - Phone:864-403-2200
Mailing Address - Fax:864-646-8025
Practice Address - Street 1:458 RIVERSIDE ST
Practice Address - Street 2:
Practice Address - City:PENDLETON
Practice Address - State:SC
Practice Address - Zip Code:29670-1211
Practice Address - Country:US
Practice Address - Phone:864-403-2200
Practice Address - Fax:864-646-8025
Is Sole Proprietor?:No
Enumeration Date:2013-01-11
Last Update Date:2013-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC68523163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC1942275649Medicaid