Healthcare Provider Details

I. General information

NPI: 1447107958
Provider Name (Legal Business Name): CAITLYN PARKER PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/13/2026
Last Update Date: 04/09/2026
Certification Date: 04/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

41 BREWSTER RD
BRISTOL CT
06010-5141
US

IV. Provider business mailing address

41 BREWSTER RD
BRISTOL CT
06010-5161
US

V. Phone/Fax

Practice location:
  • Phone: 860-585-3000
  • Fax:
Mailing address:
  • Phone: 860-585-3000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: