Provider Demographics
NPI:1730761610
Name:GRAGG, CAITLYN ALEXANDRIA (DNP, ACNP)
Entity type:Individual
Prefix:DR
First Name:CAITLYN
Middle Name:ALEXANDRIA
Last Name:GRAGG
Suffix:
Gender:F
Credentials:DNP, ACNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 4009
Mailing Address - Street 2:
Mailing Address - City:ANNAPOLIS
Mailing Address - State:MD
Mailing Address - Zip Code:21403-6009
Mailing Address - Country:US
Mailing Address - Phone:850-510-0778
Mailing Address - Fax:
Practice Address - Street 1:401 MATTHEW ST
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:OH
Practice Address - Zip Code:45750-1635
Practice Address - Country:US
Practice Address - Phone:740-374-1400
Practice Address - Fax:740-568-5688
Is Sole Proprietor?:No
Enumeration Date:2021-04-21
Last Update Date:2024-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11009067363LA2100X
OHAPRN.CNP.0036358363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care