Healthcare Provider Details

I. General information

NPI: 1467953810
Provider Name (Legal Business Name): KAYLA CAUDLE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/21/2018
Last Update Date: 05/02/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1547 PARKWAY
GREENWOOD SC
29646-4081
US

IV. Provider business mailing address

200 MCGEE RD
ANDERSON SC
29625-2104
US

V. Phone/Fax

Practice location:
  • Phone: 864-229-7120
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: