Provider Demographics
NPI:1982109641
Name:MCKEARNEY, CAITLIN ELISE (PNP)
Entity Type:Individual
Prefix:
First Name:CAITLIN
Middle Name:ELISE
Last Name:MCKEARNEY
Suffix:
Gender:F
Credentials:PNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12722 DIRECTORS LOOP
Mailing Address - Street 2:
Mailing Address - City:WOODBRIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:22192-2462
Mailing Address - Country:US
Mailing Address - Phone:703-492-1400
Mailing Address - Fax:
Practice Address - Street 1:12722 DIRECTORS LOOP
Practice Address - Street 2:
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22192-2462
Practice Address - Country:US
Practice Address - Phone:703-492-1400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-26
Last Update Date:2018-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024175996363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics