Healthcare Provider Details

I. General information

NPI: 1437508207
Provider Name (Legal Business Name): CAITLIN R SMART CPNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/12/2016
Last Update Date: 07/13/2022
Certification Date: 07/13/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 MANCHESTER RD. SUITE 105
POUGHKEEPSIE NY
12603-2587
US

IV. Provider business mailing address

301 MANCHESTER RD. SUITE 105
POUGHKEEPSIE NY
12603-2587
US

V. Phone/Fax

Practice location:
  • Phone: 845-452-1700
  • Fax: 845-452-1752
Mailing address:
  • Phone: 845-452-1700
  • Fax: 845-452-1752

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number704510-1
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberF382734-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: