Individual
CAITLIN C. OETKEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
4601 HERITAGE TRACE PKWY, FORT WORTH, TX 76244-8905
(817) 431-7985
Mailing address
4601 HERITAGE TRACE PKWY, FORT WORTH, TX 76244-8905
(817) 431-7985
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
PA12191
TX
363AM0700X
Medical Physician Assistant
PA9108543
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
014517600
—
FL
01
—
IC674Z
MCR
FL
01
—
Y0R0Q
BCBS
FL
Enumeration date
03/11/2015
Last updated
09/16/2025
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