Provider Demographics
NPI:1952770182
Name:DUVALL, CAITLIN SHINN (FNP)
Entity type:Individual
Prefix:
First Name:CAITLIN
Middle Name:SHINN
Last Name:DUVALL
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:CAITLIN
Other - Middle Name:DENISON
Other - Last Name:SHINN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP-C
Mailing Address - Street 1:6720 GOLDSTONE LN
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28211-5616
Mailing Address - Country:US
Mailing Address - Phone:045-789-1907
Mailing Address - Fax:
Practice Address - Street 1:4415 SCHOOL HOUSE CMNS
Practice Address - Street 2:
Practice Address - City:HARRISBURG
Practice Address - State:NC
Practice Address - Zip Code:28075-7558
Practice Address - Country:US
Practice Address - Phone:704-456-1218
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-09-17
Last Update Date:2022-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5007994363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1952770182Medicaid
NC1952770182Medicaid
NCNCQ376AMedicare PIN