Healthcare Provider Details

I. General information

NPI: 1144513276
Provider Name (Legal Business Name): VERONICA CAUDILL-ENGLE DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/23/2011
Last Update Date: 04/18/2022
Certification Date: 04/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

305 MORTON BLVD
HAZARD KY
41701-9418
US

IV. Provider business mailing address

2513 RIGHT FORK MACES CREEK RD
VIPER KY
41774-9025
US

V. Phone/Fax

Practice location:
  • Phone: 606-436-0514
  • Fax:
Mailing address:
  • Phone: 606-216-2599
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number03615
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: