Provider Demographics
NPI:1699215582
Name:CAFFERY, KAYTLYN K (PA)
Entity Type:Individual
Prefix:
First Name:KAYTLYN
Middle Name:K
Last Name:CAFFERY
Suffix:
Gender:F
Credentials:PA
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Mailing Address - Street 1:710 N NILES AVE
Mailing Address - Street 2:
Mailing Address - City:SOUTH BEND
Mailing Address - State:IN
Mailing Address - Zip Code:46617-1924
Mailing Address - Country:US
Mailing Address - Phone:574-647-1610
Mailing Address - Fax:574-237-6069
Practice Address - Street 1:100 NAVARRE PL STE 4470
Practice Address - Street 2:
Practice Address - City:SOUTH BEND
Practice Address - State:IN
Practice Address - Zip Code:46601-1168
Practice Address - Country:US
Practice Address - Phone:574-647-4230
Practice Address - Fax:574-647-6532
Is Sole Proprietor?:No
Enumeration Date:2017-02-27
Last Update Date:2021-04-28
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Provider Licenses
StateLicense IDTaxonomies
IN10002205A363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN300006340Medicaid