MEDICARE: CAITLYN B WILSON MHS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171M00000X	Case Manager/Care Coordinator

General Provider Information

NPI Number	:	1720867898
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CAITLYN B WILSON MHS

Provider Business Mailing Address
First Line	:	502 FONTAINE CT
Second Line	:
City	:	BREAUX BRIDGE
State	:	LA
Zip	:	70517-6296
Country	:	US
Telephone Number	:	337-680-0586
Fax Number	:

Provider Business Practice Location Address
First Line	:	11616 SOUTHFORK AVE STE 403
Second Line	:
City	:	BATON ROUGE
State	:	LA
Zip	:	70816-5241
Country	:	US
Telephone Number	:	225-261-7143
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/27/2023
Last Update Date	:	01/06/2026

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