Healthcare Provider Details

I. General information

NPI: 1619428323
Provider Name (Legal Business Name): KELLY CAUTHEN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/18/2016
Last Update Date: 10/29/2025
Certification Date: 10/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

112 S PINE ST
FLORENCE AL
35630-5509
US

IV. Provider business mailing address

PO BOX 2409
HUNTSVILLE AL
35804-2409
US

V. Phone/Fax

Practice location:
  • Phone: 256-764-0492
  • Fax:
Mailing address:
  • Phone: 256-715-4239
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1-129453
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: