Healthcare Provider Details

I. General information

NPI: 1972768422
Provider Name (Legal Business Name): LESLIE BROOKE CAUGHRON APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/24/2008
Last Update Date: 04/06/2022
Certification Date: 04/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1707 CEDAR GROVE RD STE 20
SHEPHERDSVILLE KY
40165-8592
US

IV. Provider business mailing address

PO BOX 909
LOUISVILLE KY
40201-0909
US

V. Phone/Fax

Practice location:
  • Phone: 502-215-5090
  • Fax: 502-215-5095
Mailing address:
  • Phone: 502-629-6000
  • Fax: 502-629-5991

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number3005509
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number3005509
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: