Kelly, Kaitlin M

Kelly, Kaitlin M is an individual health care provider with primary practice located at 4700 Point Fosdick Dr Ste 102 , Gig Harbor WA 98335-1706. She recently has 2 registered licenses in different health care specialties including Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant, Physician Assistants & Advanced Practice Nursing Providers / Medical. Physician Assistants & Advanced Practice Nursing Providers / Medical is her primary health care specialty. Kelly, Kaitlin M can be contacted via phone (253) 853-2050.

Contact Information

Primary practice address
4700 Point Fosdick Dr Ste 102 Gig Harbor WA 98335-1706
Phone: (253) 853-2050
Fax: (253) 853-2711
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant 363A00000X
Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant 363A00000X PA60796422 Washington
Physician Assistants & Advanced Practice Nursing Providers / Medical 363AM0700X PA60796422 Washington

Profile Details

NPI number 1972021434
LBN Legal business name Kelly, Kaitlin M
Credentials Physician's Assistant Certified (PA-C)
Entity Individual
Sole proprietor 1 No
Enumeration date Sep 5th, 2017
Last updated Oct 26th, 2020 - about 4 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1972021434 NPPES
Washington MEDICAID 2088986

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