Provider Demographics
NPI:1083384218
Name:SMALLWOOD, CAITLYN MARIEL (NP)
Entity Type:Individual
Prefix:
First Name:CAITLYN
Middle Name:MARIEL
Last Name:SMALLWOOD
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:CAITLYN
Other - Middle Name:MARIEL
Other - Last Name:PERKINS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:29943 NETWORK PL
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60673-1299
Mailing Address - Country:US
Mailing Address - Phone:317-706-3415
Mailing Address - Fax:
Practice Address - Street 1:3738 LANDMARK DR STE A
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:IN
Practice Address - Zip Code:47905-6655
Practice Address - Country:US
Practice Address - Phone:765-807-2780
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-18
Last Update Date:2023-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28244460A163WC0200X
IN71013304A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine