Provider Demographics
NPI:1629539325
Name:CAUDILL, HOLLY RENEE (DO)
Entity Type:Individual
Prefix:
First Name:HOLLY
Middle Name:RENEE
Last Name:CAUDILL
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:HOLLY
Other - Middle Name:R
Other - Last Name:WHITAKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1601 OWEN DR
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28304-3425
Mailing Address - Country:US
Mailing Address - Phone:910-678-0100
Mailing Address - Fax:910-678-7259
Practice Address - Street 1:10216 TAYLORSVILLE RD STE 500
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40299-3617
Practice Address - Country:US
Practice Address - Phone:502-928-1050
Practice Address - Fax:502-928-1050
Is Sole Proprietor?:No
Enumeration Date:2019-03-26
Last Update Date:2022-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
KY05275207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program