Healthcare Provider Details

I. General information

NPI: 1811982143
Provider Name (Legal Business Name): LYNNETTE CAUDILL WICKLIFF RN, MSN, FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/13/2005
Last Update Date: 05/25/2023
Certification Date: 05/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1130 MEDICAL PL
SEYMOUR IN
47274-2640
US

IV. Provider business mailing address

1130 MEDICAL PL
SEYMOUR IN
47274-2640
US

V. Phone/Fax

Practice location:
  • Phone: 812-519-1552
  • Fax: 812-519-1774
Mailing address:
  • Phone: 812-519-1552
  • Fax: 812-519-1774

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number71000081A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: