Healthcare Provider Details

I. General information

NPI: 1942668983
Provider Name (Legal Business Name): TABATHA FAYE CAUDILL APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/05/2016
Last Update Date: 12/07/2020
Certification Date: 12/07/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1740 NICHOLASVILLE RD
LEXINGTON KY
40503-1431
US

IV. Provider business mailing address

4071 TATES CREEK CENTRE DR SUITE 202
LEXINGTON KY
40517-3062
US

V. Phone/Fax

Practice location:
  • Phone: 859-260-6348
  • Fax: 859-260-4343
Mailing address:
  • Phone: 859-260-6348
  • Fax: 859-260-4343

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number3010072
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: