Healthcare Provider Details

I. General information

NPI: 1720378789
Provider Name (Legal Business Name): BRIA CASPERSON MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/12/2011
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1305 N ELM ST
HENDERSON KY
42420-2783
US

IV. Provider business mailing address

PO BOX 436
HENDERSON KY
42419-0436
US

V. Phone/Fax

Practice location:
  • Phone: 270-827-7700
  • Fax:
Mailing address:
  • Phone: 812-471-1591
  • Fax: 812-471-6650

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number01078488A
License Number StateIN
# 3
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberTP805
License Number StateKY
# 4
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number50188
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: