Healthcare Provider Details

I. General information

NPI: 1376992537
Provider Name (Legal Business Name): CHRISTA CAUDILL APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/08/2016
Last Update Date: 11/08/2024
Certification Date: 11/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

44 WATER ST
OWINGSVILLE KY
40360-8944
US

IV. Provider business mailing address

236 W MAIN ST
MOUNT STERLING KY
40353-1348
US

V. Phone/Fax

Practice location:
  • Phone: 606-674-9776
  • Fax:
Mailing address:
  • Phone: 859-404-7686
  • Fax: 859-498-8160

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: