Healthcare Provider Details

I. General information

NPI: 1528869096
Provider Name (Legal Business Name): CAITLYN MICHELLE NELSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/21/2025
Last Update Date: 08/17/2026
Certification Date: 08/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 STONE CREEK BLVD STE 200
FLOWOOD MS
39232-8210
US

IV. Provider business mailing address

122 SPRINGS CROSSING
MADISON MS
39110
US

V. Phone/Fax

Practice location:
  • Phone: 601-822-2294
  • Fax:
Mailing address:
  • Phone: 224-223-2115
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: