Healthcare Provider Details

I. General information

NPI: 1760966386
Provider Name (Legal Business Name): SCOTTY CAUDILL
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/19/2018
Last Update Date: 10/17/2025
Certification Date: 10/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

185 SUNNY POINT RD
JEREMIAH KY
41826-8919
US

IV. Provider business mailing address

185 SUNNY POINT RD
JEREMIAH KY
41826-8919
US

V. Phone/Fax

Practice location:
  • Phone: 606-335-2469
  • Fax: 606-487-2899
Mailing address:
  • Phone: 606-335-2469
  • Fax: 606-487-2899

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number259732
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: