Provider Demographics
NPI:1699336941
Name:MOORE, CAITLIN A (APRN)
Entity type:Individual
Prefix:
First Name:CAITLIN
Middle Name:A
Last Name:MOORE
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 1:101 EDWARDS HALL
Mailing Address - Street 2:
Mailing Address - City:CLEMSON
Mailing Address - State:SC
Mailing Address - Zip Code:29634-0001
Mailing Address - Country:US
Mailing Address - Phone:864-656-5479
Mailing Address - Fax:843-985-9562
Practice Address - Street 1:101 EDWARDS HALL
Practice Address - Street 2:
Practice Address - City:CLEMSON
Practice Address - State:SC
Practice Address - Zip Code:29634-0001
Practice Address - Country:US
Practice Address - Phone:864-656-3076
Practice Address - Fax:843-985-9562
Is Sole Proprietor?:No
Enumeration Date:2019-06-27
Last Update Date:2023-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC22970363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily