Provider Demographics
NPI:1912300211
Name:HUNTER, CAITLYN MARIE (PA-C)
Entity type:Individual
Prefix:
First Name:CAITLYN
Middle Name:MARIE
Last Name:HUNTER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1072 XRAY DR
Mailing Address - Street 2:SUITE B
Mailing Address - City:GASTONIA
Mailing Address - State:NC
Mailing Address - Zip Code:28054
Mailing Address - Country:US
Mailing Address - Phone:704-671-1094
Mailing Address - Fax:704-671-1095
Practice Address - Street 1:5815 BLAKENEY PARK DR STE 100
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28277-5732
Practice Address - Country:US
Practice Address - Phone:704-542-2220
Practice Address - Fax:704-542-3304
Is Sole Proprietor?:No
Enumeration Date:2014-09-30
Last Update Date:2020-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2194363AM0700X
NC0010-09545207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical