Provider Demographics
NPI:1740854207
Name:MAINS, CAITLYN SHELBY (FNP)
Entity type:Individual
Prefix:MRS
First Name:CAITLYN
Middle Name:SHELBY
Last Name:MAINS
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:CAITLYN
Other - Middle Name:SHELBY
Other - Last Name:BELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8829 W MARIPOSA GRANDE
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85383-1203
Mailing Address - Country:US
Mailing Address - Phone:602-653-6960
Mailing Address - Fax:
Practice Address - Street 1:5310 W THUNDERBIRD RD # 208-210
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85306-4706
Practice Address - Country:US
Practice Address - Phone:623-547-2600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-18
Last Update Date:2022-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRNP257449363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily