Provider Demographics
NPI:1003678533
Name:BROWN, KAITLYN (PA)
Entity Type:Individual
Prefix:
First Name:KAITLYN
Middle Name:
Last Name:BROWN
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:70 LERAY AVE APT 5
Mailing Address - Street 2:
Mailing Address - City:EAGLE LAKE
Mailing Address - State:MN
Mailing Address - Zip Code:56024-1404
Mailing Address - Country:US
Mailing Address - Phone:507-327-3159
Mailing Address - Fax:
Practice Address - Street 1:1400 MADISON AVE STE 400A
Practice Address - Street 2:
Practice Address - City:MANKATO
Practice Address - State:MN
Practice Address - Zip Code:56001-6805
Practice Address - Country:US
Practice Address - Phone:507-389-8538
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-29
Last Update Date:2024-01-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MN14784363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant