Provider Demographics
NPI:1558395087
Name:CAUDLE, REBECCA LYNN (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:REBECCA
Middle Name:LYNN
Last Name:CAUDLE
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Gender:F
Credentials:PA-C
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Mailing Address - Street 1:13760 N 93RD AVE STE 111
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85381-4250
Mailing Address - Country:US
Mailing Address - Phone:623-225-7546
Mailing Address - Fax:623-487-0952
Practice Address - Street 1:13760 N 93RD AVE STE 111
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85381-4250
Practice Address - Country:US
Practice Address - Phone:623-225-7546
Practice Address - Fax:623-487-0952
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2019-11-25
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Provider Licenses
StateLicense IDTaxonomies
AZ2647363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant