Provider Demographics
NPI:1942944368
Name:JACKSON, CAITLIN RACHELLE (APRN CPNP-PC)
Entity Type:Individual
Prefix:
First Name:CAITLIN
Middle Name:RACHELLE
Last Name:JACKSON
Suffix:
Gender:F
Credentials:APRN CPNP-PC
Other - Prefix:
Other - First Name:CAITLIN
Other - Middle Name:
Other - Last Name:MCMILLIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1 CHILDRENS WAY # 653
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72202-3500
Mailing Address - Country:US
Mailing Address - Phone:501-364-1100
Mailing Address - Fax:501-364-4082
Practice Address - Street 1:1 CHILDRENS WAY # 836
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72202-3500
Practice Address - Country:US
Practice Address - Phone:501-364-1225
Practice Address - Fax:501-364-3110
Is Sole Proprietor?:No
Enumeration Date:2022-04-21
Last Update Date:2023-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR219041363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics