Provider Demographics
NPI:1972768422
Name:CAUGHRON, LESLIE BROOKE (APRN)
Entity type:Individual
Prefix:
First Name:LESLIE
Middle Name:BROOKE
Last Name:CAUGHRON
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 909
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40201-0909
Mailing Address - Country:US
Mailing Address - Phone:502-629-6000
Mailing Address - Fax:502-629-5991
Practice Address - Street 1:1707 CEDAR GROVE RD STE 20
Practice Address - Street 2:
Practice Address - City:SHEPHERDSVILLE
Practice Address - State:KY
Practice Address - Zip Code:40165-8592
Practice Address - Country:US
Practice Address - Phone:502-215-5090
Practice Address - Fax:502-215-5095
Is Sole Proprietor?:No
Enumeration Date:2008-07-24
Last Update Date:2022-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3005509363LF0000X, 363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100048270Medicaid
KY50027774OtherPASSPORT HEALTH PLAN
IN200922430Medicaid
KY7100048270Medicaid
KY0773382Medicare PIN