Provider Demographics
NPI:1851052153
Name:BACON, CAITLIN MICHELLE (FNP)
Entity Type:Individual
Prefix:MRS
First Name:CAITLIN
Middle Name:MICHELLE
Last Name:BACON
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:67 CHATFIELD SQ
Mailing Address - Street 2:
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37615-4880
Mailing Address - Country:US
Mailing Address - Phone:423-794-9345
Mailing Address - Fax:
Practice Address - Street 1:105 RIVER HILLS RD
Practice Address - Street 2:
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28805-2546
Practice Address - Country:US
Practice Address - Phone:828-771-6921
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-07
Last Update Date:2022-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5015500363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner