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General NPI Number Information
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NPI Number | 1386795425
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Entity Type | Individual
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Provider Name | MARY LINDA CAPUTO CSA
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Gender | Female
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Dates
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Enumeration Date | 01/16/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1945 SCOTTSVILLE RD B2 PMB 137
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City | BOWLING GREEN
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State | KY
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Zip | 42104-3376
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Country | US
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Telephone | 270-782-0434
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Fax |
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Provider Business Mailing Address
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Address Line | 18320 CHERRYWOOD DRIVE
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City | CATLETTSBURG
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State | KY
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Zip | 41129-4210
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Country | US
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Telephone | 270-782-0434
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Fax | 270-782-0564
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number | SA007
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License Number State | KY
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