Provider Demographics
NPI:1356173041
Name:SHIPP, CAITLIN CLARE (PA)
Entity type:Individual
Prefix:MRS
First Name:CAITLIN
Middle Name:CLARE
Last Name:SHIPP
Suffix:
Gender:
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1950 DIAMOND PKWY STE 200
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64116-4329
Mailing Address - Country:US
Mailing Address - Phone:816-842-6717
Mailing Address - Fax:816-842-2574
Practice Address - Street 1:1950 DIAMOND PKWY STE 200
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64116-4329
Practice Address - Country:US
Practice Address - Phone:816-842-6717
Practice Address - Fax:816-842-2574
Is Sole Proprietor?:No
Enumeration Date:2024-08-20
Last Update Date:2025-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1503050363A00000X
363A00000X
MO2025004014363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant