Healthcare Provider Details

I. General information

NPI: 1508523796
Provider Name (Legal Business Name): TIFFANY CAUDILL APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/22/2021
Last Update Date: 09/06/2023
Certification Date: 09/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1010 MEDICAL CENTER DR
POWDERLY KY
42367-5463
US

IV. Provider business mailing address

1517 BAKER RD
BREMEN KY
42325-2853
US

V. Phone/Fax

Practice location:
  • Phone: 270-377-1600
  • Fax:
Mailing address:
  • Phone: 270-635-5061
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number3016800
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: