Healthcare Provider Details

I. General information

NPI: 1316768427
Provider Name (Legal Business Name): JESSICA CAULKINS FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/21/2024
Last Update Date: 10/21/2024
Certification Date: 10/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 CAMPUS DR STE 4
HANCOCK MI
49930-1452
US

IV. Provider business mailing address

929 EVERGREEN ST
HANCOCK MI
49930-1103
US

V. Phone/Fax

Practice location:
  • Phone: 906-483-1730
  • Fax:
Mailing address:
  • Phone: 517-425-0100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number4704289460
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: