Provider Demographics
NPI:1033954664
Name:COLE, CAITLIN M (FNP)
Entity type:Individual
Prefix:
First Name:CAITLIN
Middle Name:M
Last Name:COLE
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2811 N 31ST ST
Mailing Address - Street 2:
Mailing Address - City:OZARK
Mailing Address - State:MO
Mailing Address - Zip Code:65721-8474
Mailing Address - Country:US
Mailing Address - Phone:417-392-3081
Mailing Address - Fax:
Practice Address - Street 1:2811 N 31ST ST
Practice Address - Street 2:
Practice Address - City:OZARK
Practice Address - State:MO
Practice Address - Zip Code:65721-8474
Practice Address - Country:US
Practice Address - Phone:417-392-3081
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-26
Last Update Date:2024-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2024024799363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily