Healthcare Provider Details

I. General information

NPI: 1225471782
Provider Name (Legal Business Name): CAITLYN CECIL M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/15/2013
Last Update Date: 12/21/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2670 NEW HOLT RD STE C
PADUCAH KY
42001-7506
US

IV. Provider business mailing address

4123 MINNICH AVE
PADUCAH KY
42001-4641
US

V. Phone/Fax

Practice location:
  • Phone: 270-575-1010
  • Fax: 270-575-1018
Mailing address:
  • Phone: 859-608-0044
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number49173
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: