Provider Demographics
NPI:1801486238
Name:SHORTT, CAITLIN (FNP-C)
Entity type:Individual
Prefix:
First Name:CAITLIN
Middle Name:
Last Name:SHORTT
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:359 E HIGHWAY 32
Mailing Address - Street 2:
Mailing Address - City:FAIR PLAY
Mailing Address - State:MO
Mailing Address - Zip Code:65649-9248
Mailing Address - Country:US
Mailing Address - Phone:417-543-0453
Mailing Address - Fax:
Practice Address - Street 1:1000 E PRIMROSE ST STE 560
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65807-5194
Practice Address - Country:US
Practice Address - Phone:417-882-1600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-20
Last Update Date:2021-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOF08201442363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily