MEDICARE: CAITLIN ELIZABETH POORE PAC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant

General Provider Information

NPI Number	:	1215749742
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CAITLIN ELIZABETH POORE PAC

Provider Business Mailing Address
First Line	:	115 BREEZEWAY LN
Second Line	:
City	:	GREENSBORO
State	:	NC
Zip	:	27405-4972
Country	:	US
Telephone Number	:	440-263-0793
Fax Number	:

Provider Business Practice Location Address
First Line	:	1200 N ELM ST
Second Line	:
City	:	GREENSBORO
State	:	NC
Zip	:	27401-1004
Country	:	US
Telephone Number	:	336-832-8040
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/22/2025
Last Update Date	:	12/05/2025

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Directions to “ CAITLIN ELIZABETH POORE PAC” Practice Location

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