Healthcare Provider Details

I. General information

NPI: 1205583036
Provider Name (Legal Business Name): CAITLIN PREECE FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/02/2022
Last Update Date: 08/09/2023
Certification Date: 08/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

314 GOFF MOUNTAIN RD STE 3
CROSS LANES WV
25313-6600
US

IV. Provider business mailing address

501 MORRIS ST
CHARLESTON WV
25301-1326
US

V. Phone/Fax

Practice location:
  • Phone: 304-388-7070
  • Fax:
Mailing address:
  • Phone: 304-647-6006
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number73241
License Number StateWV
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number112058
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: