MRS. CAITLEN M PETSCHKE PA-C NPI 1558669986

NPI Information

NPI: 1558669986
Provider Name: MRS. CAITLEN M PETSCHKE, PA-C
Classification: Physician Assistant - 363AM0700X
Entity Type: Individual

Specialization: Medical

Organization: BLUE RIDGE MEDICAL MANAGEMENT CORPORATION

PECOS Registration: Yes

Address:
101 MED TECH PKWY
STE. 405
JOHNSON CITY, TN
ZIP 37604
Phone: (423) 929-2452
Get Directions

MRS. Caitlen M Petschke, PA-C is a medical physician assistant in Johnson City, TN with 14 years of experience. MRS. Caitlen M Petschke, PA-C NPI is 1558669986. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a female.

The provider's business location address is:

101 MED TECH PKWY
STE. 405
JOHNSON CITY, TN
ZIP 37604-007
Phone: (423) 929-2452
Fax: (423) 929-2531

The NPI 1558669986 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment, Part A Home Health Agency (HHA), Power Mobility Devices.

The enumeration date for this NPI number is 3/9/2011 and was last updated on 8/15/2013.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	363AM0700X	Physician Assistant	Medical	PA200351	LOUISIANA	No
2	363AM0700X	Physician Assistant	Medical	2275	TENNESSEE	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	2158848	MEDICAID	LOUISIANA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/14/2023

NPI Synchronization or Removal

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