Healthcare Provider Details

I. General information

NPI: 1952231094
Provider Name (Legal Business Name): ALEXANDRA PAIGE CAUDILL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/20/2026
Last Update Date: 05/20/2026
Certification Date: 05/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6178 COLLEGE STATION DR
WILLIAMSBURG KY
40769-1372
US

IV. Provider business mailing address

383 WOODLAND HTS
EAST POINT KY
41216-9068
US

V. Phone/Fax

Practice location:
  • Phone: 606-549-2200
  • Fax: 606-539-4347
Mailing address:
  • Phone: 606-616-1835
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number1153656
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: