Provider Demographics
NPI:1417925983
Name:CAUDILL, DEBRA K (CNP)
Entity Type:Individual
Prefix:
First Name:DEBRA
Middle Name:K
Last Name:CAUDILL
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:248 TAR HEEL DR
Mailing Address - Street 2:
Mailing Address - City:DELAWARE
Mailing Address - State:OH
Mailing Address - Zip Code:43015-4091
Mailing Address - Country:US
Mailing Address - Phone:740-363-0441
Mailing Address - Fax:
Practice Address - Street 1:248 TAR HEEL DR
Practice Address - Street 2:
Practice Address - City:DELAWARE
Practice Address - State:OH
Practice Address - Zip Code:43015-4091
Practice Address - Country:US
Practice Address - Phone:740-363-0441
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-10
Last Update Date:2013-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN134783-COA1363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2258060Medicaid
P34387Medicare UPIN