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General NPI Number Information
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NPI Number | 1013469139
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Entity Type | Individual
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Provider Name | CAITLIN RALSTON PA-C
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Gender | Female
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Dates
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Enumeration Date | 10/25/2016
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Last Update Date | 03/06/2020
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Provider Practice Location Address
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Address Line | 100 SCHUYLKILL MED PLZ SUITE 202
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City | POTTSVILLE
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State | PA
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Zip | 17901-3636
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Country | US
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Telephone | 570-621-5987
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Fax | 570-621-5980
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Provider Business Mailing Address
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Address Line | PO BOX 783311
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City | PHILADELPHIA
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State | PA
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Zip | 19178-3311
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Country | US
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Telephone | 484-884-4500
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Fax | 484-884-0699
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | MA058688
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | OA003996
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License Number State | PA
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