Provider Demographics
NPI:1710271556
Name:CAUDILLO, ELIZABETH ERSKINE (PA)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:ERSKINE
Last Name:CAUDILLO
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 W 13TH ST
Mailing Address - Street 2:
Mailing Address - City:HARPER
Mailing Address - State:KS
Mailing Address - Zip Code:67058-1401
Mailing Address - Country:US
Mailing Address - Phone:620-896-7324
Mailing Address - Fax:620-896-2084
Practice Address - Street 1:700 W 13TH ST
Practice Address - Street 2:
Practice Address - City:HARPER
Practice Address - State:KS
Practice Address - Zip Code:67058-1401
Practice Address - Country:US
Practice Address - Phone:620-896-7324
Practice Address - Fax:620-896-2084
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-08
Last Update Date:2016-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1501443363A00000X
OK1931363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant