Provider Demographics
NPI:1033363528
Name:PHELPS JESSEL, CAITLIN (PA-C)
Entity Type:Individual
Prefix:
First Name:CAITLIN
Middle Name:
Last Name:PHELPS JESSEL
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 1:11 WHITEHALL RD
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NH
Mailing Address - Zip Code:03867-3226
Mailing Address - Country:US
Mailing Address - Phone:603-335-8171
Mailing Address - Fax:603-335-8199
Practice Address - Street 1:11 WHITEHALL RD
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NH
Practice Address - Zip Code:03867-3226
Practice Address - Country:US
Practice Address - Phone:603-335-8171
Practice Address - Fax:603-335-8199
Is Sole Proprietor?:No
Enumeration Date:2008-11-10
Last Update Date:2023-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPA1357363A00000X
NH0702363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH3131840Medicaid