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General NPI Number Information
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NPI Number | 1790454650
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Entity Type | Individual
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Provider Name | JARED CAUDILL RN
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Gender | Male
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Dates
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Enumeration Date | 09/13/2021
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Last Update Date | 09/13/2021
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Provider Practice Location Address
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Address Line | 3512 STELLHORN RD
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City | FORT WAYNE
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State | IN
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Zip | 46815-4631
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Country | US
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Telephone | 260-483-9081
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Fax | 260-483-9196
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Provider Business Mailing Address
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Address Line | PO BOX 392552
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City | PITTSBURGH
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State | PA
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Zip | 15251-9552
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Country | US
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Telephone | 512-792-4402
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Fax | 512-792-4420
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 28189591A
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License Number State | IN
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