Provider Demographics
NPI:1649712464
Name:CAUTHORNE, AYANNA
Entity type:Individual
Prefix:
First Name:AYANNA
Middle Name:
Last Name:CAUTHORNE
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 1:25793 TIDEWATER TRL
Mailing Address - Street 2:
Mailing Address - City:TAPPAHANNOCK
Mailing Address - State:VA
Mailing Address - Zip Code:22560-4930
Mailing Address - Country:US
Mailing Address - Phone:804-445-4188
Mailing Address - Fax:804-843-1070
Practice Address - Street 1:25793 TIDEWATER TRL
Practice Address - Street 2:
Practice Address - City:TAPPAHANNOCK
Practice Address - State:VA
Practice Address - Zip Code:22560-4930
Practice Address - Country:US
Practice Address - Phone:800-444-5418
Practice Address - Fax:804-843-1070
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-10
Last Update Date:2017-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA814263597251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health