Provider Demographics
NPI:1295187938
Name:JENNINGS, CAITLYN ROSE (PA-C)
Entity Type:Individual
Prefix:
First Name:CAITLYN
Middle Name:ROSE
Last Name:JENNINGS
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 1:26 W MAIN ST STE 3A
Mailing Address - Street 2:
Mailing Address - City:HYRUM
Mailing Address - State:UT
Mailing Address - Zip Code:84319-1293
Mailing Address - Country:US
Mailing Address - Phone:435-245-6248
Mailing Address - Fax:435-245-3637
Practice Address - Street 1:26 W MAIN ST STE 3A
Practice Address - Street 2:
Practice Address - City:HYRUM
Practice Address - State:UT
Practice Address - Zip Code:84319-1293
Practice Address - Country:US
Practice Address - Phone:435-245-6248
Practice Address - Fax:435-245-3637
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-06
Last Update Date:2023-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT9860392-1206363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical