Provider Demographics
NPI:1528869096
Name:NELSON, CAITLYN MICHELLE
Entity type:Individual
Prefix:
First Name:CAITLYN
Middle Name:MICHELLE
Last Name:NELSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6721 WASHINGTON AVE APT 28J
Mailing Address - Street 2:
Mailing Address - City:OCEAN SPRINGS
Mailing Address - State:MS
Mailing Address - Zip Code:39564-2175
Mailing Address - Country:US
Mailing Address - Phone:224-223-2115
Mailing Address - Fax:
Practice Address - Street 1:1001 N HALSTEAD RD
Practice Address - Street 2:
Practice Address - City:OCEAN SPRINGS
Practice Address - State:MS
Practice Address - Zip Code:39564-3121
Practice Address - Country:US
Practice Address - Phone:228-818-0416
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-21
Last Update Date:2025-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant