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NPI Code Detail

MEDICARE: ALLIE CAUDILL

MEDICARE: ALLIE CAUDILL
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
1207Q00000XFamily Medicine PhysicianED1046WV
2207Q00000XFamily Medicine PhysicianTP342KY

General Provider Information

NPI Number : 1861060576
Entity Type Code : Individual
Provider Name (Legal Business Name) : ALLIE CAUDILL
Provider Business Mailing Address
First Line : 252 RURAL ACRES DR
Second Line :
City : BECKLEY
State : WV
Zip : 25801-3503
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 391 W TOM T HALL BLVD
Second Line :
City : OLIVE HILL
State : KY
Zip : 41164-7688
Country : US
Telephone Number : 606-286-8039
Fax Number : 606-286-6108
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/17/2021
Last Update Date : 07/25/2024

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Directions to “ ALLIE CAUDILL ” Practice Location

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