Healthcare Provider Details

I. General information

NPI: 1801780549
Provider Name (Legal Business Name): ALEXIS CAUGHERTY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/06/2025
Last Update Date: 06/06/2025
Certification Date: 06/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

281 W LANE AVE
COLUMBUS OH
43210-1132
US

IV. Provider business mailing address

145 KENNEDY PARK DR
GRANVILLE OH
43023-6501
US

V. Phone/Fax

Practice location:
  • Phone: 614-292-6446
  • Fax:
Mailing address:
  • Phone: 614-506-6130
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: