MEDICARE: JESSICA COMBS CAUDILL MS, RD, LD

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	133V00000X	Registered Dietitian	ND7422	FL
2	133V00000X	Registered Dietitian	121391	KY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2551	OTHER	KY	KY DIETITIANS AND NUTRITIONISTS LICENSE

General Provider Information

NPI Number	:	1134535255
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESSICA COMBS CAUDILL MS, RD, LD

Provider Business Mailing Address
First Line	:	1548 FLEMISHBOND PATH
Second Line	:
City	:	LEXINGTON
State	:	KY
Zip	:	40509-8706
Country	:	US
Telephone Number	:	859-595-3638
Fax Number	:	859-595-3638

Provider Business Practice Location Address
First Line	:	1548 FLEMISHBOND PATH
Second Line	:
City	:	LEXINGTON
State	:	KY
Zip	:	40509-8706
Country	:	US
Telephone Number	:	859-595-3638
Fax Number	:

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

Provider Enumeration Date	:	07/09/2014
Last Update Date	:	10/07/2024

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