Provider Demographics
NPI:1184237711
Name:BAILEY, CAITLIN NICOLE
Entity type:Individual
Prefix:
First Name:CAITLIN
Middle Name:NICOLE
Last Name:BAILEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:879 S OREM BLVD STE 1
Mailing Address - Street 2:
Mailing Address - City:OREM
Mailing Address - State:UT
Mailing Address - Zip Code:84058-5030
Mailing Address - Country:US
Mailing Address - Phone:801-802-8608
Mailing Address - Fax:801-221-1042
Practice Address - Street 1:5698 W GLEN EAGLE DR
Practice Address - Street 2:
Practice Address - City:WEST VALLEY
Practice Address - State:UT
Practice Address - Zip Code:84128-4013
Practice Address - Country:US
Practice Address - Phone:801-917-5457
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-24
Last Update Date:2021-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program