Provider Demographics
NPI:1750028767
Name:CAINES, JOHN ALDEN
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:ALDEN
Last Name:CAINES
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23 PATRICK CT
Mailing Address - Street 2:
Mailing Address - City:PIKEVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:41501-8702
Mailing Address - Country:US
Mailing Address - Phone:606-422-4013
Mailing Address - Fax:
Practice Address - Street 1:3797 GREASY CRK
Practice Address - Street 2:
Practice Address - City:SHELBIANA
Practice Address - State:KY
Practice Address - Zip Code:41562-8507
Practice Address - Country:US
Practice Address - Phone:606-422-4013
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-19
Last Update Date:2022-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1204259175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist