Healthcare Provider Details

I. General information

NPI: 1205730306
Provider Name (Legal Business Name): CAITLIN DULLE PUCKETT RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/05/2026
Last Update Date: 10/05/2026
Certification Date: 10/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3900 AMBASSADOR DR
ANCHORAGE AK
99508-5922
US

IV. Provider business mailing address

9850 MAIN TREE DR
ANCHORAGE AK
99507-6707
US

V. Phone/Fax

Practice location:
  • Phone: 907-729-3928
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: