Individual provider Active NPI

Delisa Caudill, APRN

  • Nurse Practitioner
  • Prestonsburg, KY
National Provider Identifier
1629471602
Registry record updated Aug 7, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
APRN11033598 Issued in FL
Practice address
5322 Ky Route 321
Prestonsburg, KY 41653-9114
Phone
(606) 886-2712
Fax
(606) 886-2713
NPI assigned
Oct 3, 2014
Last updated
Aug 7, 2026By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 7, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X APRN11033598 FL Primary
Family Nurse Practitioner 363LF0000X 3008916 KY

Addresses

Primary practice location

5322 Ky Route 321
Prestonsburg, KY 41653-9114

Mailing address

5322 Ky Route 321
Prestonsburg, KY 41653-9114
Phone (606) 886-2712

Electronic endpoints 2

TypeEndpointUseAffiliation
Direct Messaging Address dcaudill05@arh.medalliesdirect.net Direct
Direct Messaging Address DeLisa.Caudill@img.directbygreenway.com Direct

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in KY
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20141110000413 KY Practitioner - Nurse Practitioner 4880816784 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2014
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

5000 Ky Route 321
Suite 1001
Prestonsburg, KY 41653-9113
Phone (606) 889-6390

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
APRN11033598FLMDNurse Practitioner
3008916KYMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Intercoastal Medical Group Inc CurrentSince Aug 26, 2024 Accepting new patients

Locations

3333 Cattlemen Rd
Ste 204
Sarasota, FL 34232
Phone (941) 342-8892

943 S Beneva Rd
Ste 306
Sarasota, FL 34232
Phone (941) 362-8644

921 S Beneva Rd
Sarasota, FL 34232
Phone (941) 365-7390

Interoperability endpoints

  • Direct secure messaging: delisa.caudill@img.directbygreenway.com

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 2

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1412294400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1786060800000",
    "number": "1629471602",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5322 KY ROUTE 321",
            "city": "PRESTONSBURG",
            "state": "KY",
            "postal_code": "416539114",
            "telephone_number": "606-886-2712",
            "fax_number": "606-886-2713"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5322 KY ROUTE 321",
            "city": "PRESTONSBURG",
            "state": "KY",
            "postal_code": "416539114",
            "telephone_number": "606-886-2712",
            "fax_number": "606-886-2713"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CAUDILL",
        "first_name": "DELISA",
        "credential": "APRN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-10-03",
        "last_updated": "2026-08-07",
        "certification_date": "2026-08-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "FL",
            "license": "APRN11033598",
            "primary": true
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "KY",
            "license": "3008916",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "dcaudill05@arh.medalliesdirect.net",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "Standard Direct Functionality",
            "address_1": "5322 Ky Route 321",
            "city": "Prestonsburg",
            "state": "KY",
            "country_code": "US",
            "postal_code": "416539114",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "DeLisa.Caudill@img.directbygreenway.com",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "3333 Cattlemen Rd Ste 204",
            "city": "Sarasota",
            "state": "FL",
            "country_code": "US",
            "postal_code": "342326058",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Prestonsburg, KY

Sources for this page

Verify at the official NPI Registry.