Provider Demographics
NPI:1083954929
Name:CAUDLE, KELLY S (PA-C)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:S
Last Name:CAUDLE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:200 COOL SPRINGS BLVD
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:TN
Mailing Address - Zip Code:37067-2677
Mailing Address - Country:US
Mailing Address - Phone:615-224-2670
Mailing Address - Fax:615-224-2671
Practice Address - Street 1:200 COOL SPRINGS BLVD
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:TN
Practice Address - Zip Code:37067-2677
Practice Address - Country:US
Practice Address - Phone:615-224-2670
Practice Address - Fax:615-224-2671
Is Sole Proprietor?:No
Enumeration Date:2013-02-28
Last Update Date:2013-04-16
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical