Provider Demographics
NPI:1437668175
Name:SHULL, CAITLIN ABISEID (APRN)
Entity Type:Individual
Prefix:
First Name:CAITLIN
Middle Name:ABISEID
Last Name:SHULL
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1100
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:AR
Mailing Address - Zip Code:72031-1100
Mailing Address - Country:US
Mailing Address - Phone:501-745-2800
Mailing Address - Fax:501-745-8864
Practice Address - Street 1:194 SHAKE RAG RD
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:AR
Practice Address - Zip Code:72031
Practice Address - Country:US
Practice Address - Phone:501-745-2800
Practice Address - Fax:501-745-8864
Is Sole Proprietor?:No
Enumeration Date:2017-09-26
Last Update Date:2018-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA005223363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily