Provider Demographics
NPI:1811732399
Name:O'CONNER, CAITLIN MACKENZIE (DNP, FNP-C)
Entity type:Individual
Prefix:
First Name:CAITLIN
Middle Name:MACKENZIE
Last Name:O'CONNER
Suffix:
Gender:F
Credentials:DNP, FNP-C
Other - Prefix:
Other - First Name:CAITLIN
Other - Middle Name:MACKENZIE
Other - Last Name:SKALICKY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7864 RICHMOND TAPPAHANNOCK HWY
Mailing Address - Street 2:
Mailing Address - City:AYLETT
Mailing Address - State:VA
Mailing Address - Zip Code:23009-3056
Mailing Address - Country:US
Mailing Address - Phone:804-535-0145
Mailing Address - Fax:
Practice Address - Street 1:7864 RICHMOND TAPPAHANNOCK HWY
Practice Address - Street 2:
Practice Address - City:AYLETT
Practice Address - State:VA
Practice Address - Zip Code:23009-3056
Practice Address - Country:US
Practice Address - Phone:804-769-2015
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-27
Last Update Date:2024-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024190558363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA3001529971Medicaid