Healthcare Provider Details

I. General information

NPI: 1912093238
Provider Name (Legal Business Name): SONYA A CALDWELL PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/05/2006
Last Update Date: 01/08/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1107 BELLEFONTE RD
FLATWOODS KY
41139-2503
US

IV. Provider business mailing address

2201 LEXINGTON AVE
ASHLAND KY
41101-2843
US

V. Phone/Fax

Practice location:
  • Phone: 606-834-0125
  • Fax: 606-834-0128
Mailing address:
  • Phone: 606-327-5044
  • Fax: 606-327-7425

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA149
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: