Healthcare Provider Details

I. General information

NPI: 1649712464
Provider Name (Legal Business Name): AYANNA CAUTHORNE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/10/2016
Last Update Date: 04/18/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25793 TIDEWATER TRL
TAPPAHANNOCK VA
22560-4930
US

IV. Provider business mailing address

25793 TIDEWATER TRL
TAPPAHANNOCK VA
22560-4930
US

V. Phone/Fax

Practice location:
  • Phone: 800-444-5418
  • Fax: 804-843-1070
Mailing address:
  • Phone: 804-445-4188
  • Fax: 804-843-1070

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number814263597
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: