Provider Demographics
NPI:1134596828
Name:POELKING, CAITLIN DELANEY (PA-C)
Entity type:Individual
Prefix:
First Name:CAITLIN
Middle Name:DELANEY
Last Name:POELKING
Suffix:
Gender:
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2614 AVENGER PL UNIT 3
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80524-4907
Mailing Address - Country:US
Mailing Address - Phone:301-275-8300
Mailing Address - Fax:
Practice Address - Street 1:3351 EASTBROOK DR STE 200
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80525-5744
Practice Address - Country:US
Practice Address - Phone:970-500-0164
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-28
Last Update Date:2025-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDC05841363A00000X
CO363AM0700X
COPA.0005134363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO9000153459Medicaid
COPA.0005134OtherCOLORADO STATE LICENSE
MDC05841OtherMARYLAND STATE LICENSE