Provider Demographics
NPI:1790837078
Name:CAUDILL-KUHN, JANICE KAY (APRN, PHD)
Entity Type:Individual
Prefix:
First Name:JANICE
Middle Name:KAY
Last Name:CAUDILL-KUHN
Suffix:
Gender:F
Credentials:APRN, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19330 PACIFIC ST
Mailing Address - Street 2:
Mailing Address - City:ELKHORN
Mailing Address - State:NE
Mailing Address - Zip Code:68022-2718
Mailing Address - Country:US
Mailing Address - Phone:402-289-3247
Mailing Address - Fax:
Practice Address - Street 1:1919 S 40TH ST STE 320
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68506-5248
Practice Address - Country:US
Practice Address - Phone:402-488-5765
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-17
Last Update Date:2015-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NEMC0833120103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NEDTH001Medicare UPIN