Provider Demographics
NPI:1538781075
Name:KELLEY, CAITLIN SHEA (RN)
Entity type:Individual
Prefix:
First Name:CAITLIN
Middle Name:SHEA
Last Name:KELLEY
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9872 SOFTWATER WAY
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21046-1825
Mailing Address - Country:US
Mailing Address - Phone:443-812-1218
Mailing Address - Fax:
Practice Address - Street 1:9872 SOFTWATER WAY
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21046-1825
Practice Address - Country:US
Practice Address - Phone:443-812-1218
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-07
Last Update Date:2020-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR215818163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse