Healthcare Provider Details

I. General information

NPI: 1316655152
Provider Name (Legal Business Name): CAITLIN ACKERET
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/10/2022
Last Update Date: 11/10/2022
Certification Date: 11/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2626 17TH ST
COLUMBUS IN
47201-5417
US

IV. Provider business mailing address

2626 17TH ST
COLUMBUS IN
47201-5417
US

V. Phone/Fax

Practice location:
  • Phone: 800-841-4938
  • Fax: 812-376-5610
Mailing address:
  • Phone: 812-376-5609
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number71013206A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: