Provider Demographics
NPI:1639963580
Name:KIMBERLY CAUDELL, PLLC
Entity type:Organization
Organization Name:KIMBERLY CAUDELL, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:DAWN
Authorized Official - Last Name:CAUDELL
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:304-660-8292
Mailing Address - Street 1:500 MOUNTAIN DR
Mailing Address - Street 2:
Mailing Address - City:PEARISBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24134-1111
Mailing Address - Country:US
Mailing Address - Phone:304-660-8292
Mailing Address - Fax:304-929-0786
Practice Address - Street 1:330 N EISENHOWER DR APT SUITE
Practice Address - Street 2:
Practice Address - City:BECKLEY
Practice Address - State:WV
Practice Address - Zip Code:25801-4122
Practice Address - Country:US
Practice Address - Phone:304-660-8292
Practice Address - Fax:304-929-2278
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-04-07
Last Update Date:2025-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty