Provider Demographics
NPI:1336698695
Name:HALL, CAITLIN CASSADY CHRYSTAL (PA-C)
Entity Type:Individual
Prefix:
First Name:CAITLIN
Middle Name:CASSADY CHRYSTAL
Last Name:HALL
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:CAITLIN
Other - Middle Name:CASSADY
Other - Last Name:CHRYSTAL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3126 N CIVIC CENTER PLZ
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85251-6912
Mailing Address - Country:US
Mailing Address - Phone:480-874-2040
Mailing Address - Fax:
Practice Address - Street 1:2222 E HIGHLAND AVE STE 300
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85016-4879
Practice Address - Country:US
Practice Address - Phone:602-277-6211
Practice Address - Fax:602-277-1074
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-28
Last Update Date:2019-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ6485363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant