Provider Demographics
NPI:1811718232
Name:CALIXTO, CHARLOTTE R (PA-C)
Entity type:Individual
Prefix:
First Name:CHARLOTTE
Middle Name:R
Last Name:CALIXTO
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:CHARLOTTE
Other - Middle Name:R
Other - Last Name:WOOLSTENHULME
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:635 N NC 16 BUSINESS HWY
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:NC
Mailing Address - Zip Code:28037-7574
Mailing Address - Country:US
Mailing Address - Phone:704-489-8401
Mailing Address - Fax:
Practice Address - Street 1:635 N NC 16 BUSINESS HWY
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:NC
Practice Address - Zip Code:28037-7574
Practice Address - Country:US
Practice Address - Phone:704-489-8401
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-18
Last Update Date:2024-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA12641363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant