Provider Demographics
NPI:1104220649
Name:CAUTHEN, VINTEARIA
Entity Type:Individual
Prefix:
First Name:VINTEARIA
Middle Name:
Last Name:CAUTHEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6949 AMBERLY VILLAGE DR
Mailing Address - Street 2:
Mailing Address - City:CORDOVA
Mailing Address - State:TN
Mailing Address - Zip Code:38018-5619
Mailing Address - Country:US
Mailing Address - Phone:901-258-9702
Mailing Address - Fax:
Practice Address - Street 1:3430 HALLBROOK ST
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38127-5626
Practice Address - Country:US
Practice Address - Phone:901-258-9702
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-10-13
Last Update Date:2014-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver