Healthcare Provider Details

I. General information

NPI: 1144970179
Provider Name (Legal Business Name): CAITLIN T. HENRY MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/24/2022
Last Update Date: 12/29/2025
Certification Date: 12/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

375 S CHIPETA WAY STE A
SALT LAKE CITY UT
84108-1261
US

IV. Provider business mailing address

375 S CHIPETA WAY STE A
SALT LAKE CITY UT
84108-1261
US

V. Phone/Fax

Practice location:
  • Phone: 801-587-3411
  • Fax:
Mailing address:
  • Phone: 801-581-2121
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number13510324-1205
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: