=====================================================
General NPI Number Information
=====================================================
NPI Number | 1760208441
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CAITLIN ELIZABETH WATERS APRN-CNP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/27/2024
-----------------------------------------------------
Last Update Date | 06/23/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 106 W RAY FINE BOULEVARD SUITE 3
-----------------------------------------------------
City | ROLAND
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 74954
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 918-571-4332
-----------------------------------------------------
Fax | 918-571-4381
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 106 W RAY FINE BOULEVARD SUITE 3
-----------------------------------------------------
City | ROLAND
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 74954
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 918-571-4332
-----------------------------------------------------
Fax | 918-571-4381
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | 230935
-----------------------------------------------------
License Number State | AR
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 363LP2300X
-----------------------------------------------------
Taxonomy Name | Primary Care Nurse Practitioner
-----------------------------------------------------
License Number | 217058
-----------------------------------------------------
License Number State | OK
-----------------------------------------------------