Provider Demographics
NPI:1427736289
Name:CAUDILL, JERIMIE CHRISTOPHER (FNP-C)
Entity type:Individual
Prefix:
First Name:JERIMIE
Middle Name:CHRISTOPHER
Last Name:CAUDILL
Suffix:
Gender:M
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8710 N FIVE FORKS RD
Mailing Address - Street 2:
Mailing Address - City:AMELIA COURT HOUSE
Mailing Address - State:VA
Mailing Address - Zip Code:23002-4846
Mailing Address - Country:US
Mailing Address - Phone:804-305-1850
Mailing Address - Fax:
Practice Address - Street 1:2410 PAGEHURST DR
Practice Address - Street 2:
Practice Address - City:MIDLOTHIAN
Practice Address - State:VA
Practice Address - Zip Code:23113-6411
Practice Address - Country:US
Practice Address - Phone:804-897-6140
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-10
Last Update Date:2023-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VAF07230354363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily