Provider Demographics
NPI:1053083600
Name:SMITH, KAITLIN S (CPNP)
Entity type:Individual
Prefix:
First Name:KAITLIN
Middle Name:S
Last Name:SMITH
Suffix:
Gender:F
Credentials:CPNP
Other - Prefix:
Other - First Name:KAITLIN
Other - Middle Name:S
Other - Last Name:ALLEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7010 E CHAUNCEY LN STE 225
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85054-3117
Mailing Address - Country:US
Mailing Address - Phone:480-585-5200
Mailing Address - Fax:480-585-5233
Practice Address - Street 1:7333 E THOMAS RD
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85251-7215
Practice Address - Country:US
Practice Address - Phone:480-585-5200
Practice Address - Fax:480-585-5233
Is Sole Proprietor?:No
Enumeration Date:2021-10-01
Last Update Date:2024-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ276788363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics