Individual
MRS. CAITLEN M PETSCHKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
101 MED TECH PKWY, STE. 405, JOHNSON CITY, TN 37604-4007
(423) 929-2452
(423) 929-2531
Mailing address
101 MED TECH PKWY, STE. 405, JOHNSON CITY, TN 37604-4007
(423) 929-2452
(423) 929-2531
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
2275
TN
363AM0700X
Medical Physician Assistant
PA200351
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2158848
—
LA
Enumeration date
03/09/2011
Last updated
08/15/2013
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