Provider Demographics
NPI:1659803302
Name:CAUDLE, CORRIE VONNE
Entity Type:Individual
Prefix:
First Name:CORRIE
Middle Name:VONNE
Last Name:CAUDLE
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 1:1809 OAKRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:SEMINOLE
Mailing Address - State:OK
Mailing Address - Zip Code:74868-3623
Mailing Address - Country:US
Mailing Address - Phone:405-380-7536
Mailing Address - Fax:
Practice Address - Street 1:1809 OAKRIDGE DR
Practice Address - Street 2:
Practice Address - City:SEMINOLE
Practice Address - State:OK
Practice Address - Zip Code:74868-3623
Practice Address - Country:US
Practice Address - Phone:405-380-7536
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-31
Last Update Date:2017-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator