Healthcare Provider Details

I. General information

NPI: 1326449182
Provider Name (Legal Business Name): CAITLIN ANNE ANDRYKA PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CAITLIN ANNE ROTHMAN PA-C

II. Dates (important events)

Enumeration Date: 09/11/2014
Last Update Date: 11/09/2020
Certification Date: 11/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6 SHACKLEFORD DR
LITTLE ROCK AR
72211-2858
US

IV. Provider business mailing address

90 JACKSON PIKE
GALLIPOLIS OH
45631-1560
US

V. Phone/Fax

Practice location:
  • Phone: 501-500-5001
  • Fax:
Mailing address:
  • Phone: 740-446-5201
  • Fax: 740-446-5486

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number50.004120
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA-795
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: