Provider Demographics
NPI:1629439476
Name:COLOSKY, CAITLIN ELIZABETH (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:CAITLIN
Middle Name:ELIZABETH
Last Name:COLOSKY
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:CAITLIN
Other - Middle Name:ELIZABETH
Other - Last Name:BARAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:5829 GOLIAD AVE
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75206-6817
Mailing Address - Country:US
Mailing Address - Phone:817-602-6302
Mailing Address - Fax:
Practice Address - Street 1:1615 HOSPITAL PKWY
Practice Address - Street 2:SUITE 306
Practice Address - City:BEDFORD
Practice Address - State:TX
Practice Address - Zip Code:76022-5934
Practice Address - Country:US
Practice Address - Phone:817-684-5106
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-03-08
Last Update Date:2017-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical