Active NPI
Carol L Maccallum, NP
- Family Nurse Practitioner
- Castle Rock, CO
National Provider Identifier
1477570455
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Nurse Practitioner
- License
- 4174
- Practice address
- 4606 Gray Wolf LN
Castle Rock, CO 80104-3570 - Phone
- (720) 767-4686
- NPI assigned
- Jul 16, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Nurse Practitioner | 363LF0000X | 4174 | CO | Primary |
Addresses
Primary practice location
4606 Gray Wolf LN
Castle Rock, CO 80104-3570
Mailing address
4606 Gray Wolf LN
Castle Rock, CO 80104-3570
Phone (720) 767-4686
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 91082056 | Medicaid | CO | |
| C-APN4174 | Other | CO | STATE NP LICENSE |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 4174 | CO | MD | Family Nurse Practitioner |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1153008000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1739318400000",
"number": "1477570455",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4606 GRAY WOLF LN",
"city": "CASTLE ROCK",
"state": "CO",
"postal_code": "801043570",
"telephone_number": "720-767-4686"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4606 GRAY WOLF LN",
"city": "CASTLE ROCK",
"state": "CO",
"postal_code": "801043570",
"telephone_number": "720-767-4686"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MACCALLUM",
"first_name": "CAROL",
"middle_name": "L",
"credential": "NP",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-07-16",
"last_updated": "2025-02-12",
"certification_date": "2025-02-12",
"status": "A"
},
"taxonomies": [
{
"code": "363LF0000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Family",
"state": "CO",
"license": "4174",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "91082056",
"state": "CO"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "STATE NP LICENSE",
"identifier": "C-APN4174",
"state": "CO"
}
],
"endpoints": [],
"other_names": []
}Other providers in Castle Rock, CO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 12, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.