MEDICARE: MS. MADELINE JUNE CAULK RN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse	1168007	KY

General Provider Information

NPI Number	:	1073494456
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MADELINE JUNE CAULK RN

Provider Business Mailing Address
First Line	:	9103 CROWNE SPRINGS CIR UNIT 301
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40241-8142
Country	:	US
Telephone Number	:	502-552-1780
Fax Number	:

Provider Business Practice Location Address
First Line	:	9103 CROWNE SPRINGS CIR UNIT 301
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40241-8142
Country	:	US
Telephone Number	:	502-552-1780
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/11/2025
Last Update Date	:	09/11/2025

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