Provider Demographics
NPI:1053083600
Name:ALLEN, KAITLIN S
Entity Type:Individual
Prefix:
First Name:KAITLIN
Middle Name:S
Last Name:ALLEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:410 W 1ST ST UNIT 102
Mailing Address - Street 2:
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85281-2874
Mailing Address - Country:US
Mailing Address - Phone:480-272-1101
Mailing Address - Fax:
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:2024-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ276788363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics