Provider Demographics
NPI:1386795425
Name:CAPUTO, MARY LINDA (CSA)
Entity type:Individual
Prefix:MRS
First Name:MARY
Middle Name:LINDA
Last Name:CAPUTO
Suffix:
Gender:F
Credentials:CSA
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:18320 CHERRYWOOD DRIVE
Mailing Address - Street 2:
Mailing Address - City:CATLETTSBURG
Mailing Address - State:KY
Mailing Address - Zip Code:41129-4210
Mailing Address - Country:US
Mailing Address - Phone:270-782-0434
Mailing Address - Fax:270-782-0564
Practice Address - Street 1:1945 SCOTTSVILLE RD
Practice Address - Street 2:B2 PMB 137
Practice Address - City:BOWLING GREEN
Practice Address - State:KY
Practice Address - Zip Code:42104-3376
Practice Address - Country:US
Practice Address - Phone:270-782-0434
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYSA007363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY007OtherKCSA