Provider Demographics
NPI:1083498554
Name:MUNNS, KAITLIN RENETTE (APRN-CNP)
Entity Type:Individual
Prefix:MRS
First Name:KAITLIN
Middle Name:RENETTE
Last Name:MUNNS
Suffix:
Gender:F
Credentials:APRN-CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:625 POLE LINE RD W STE 2A
Mailing Address - Street 2:
Mailing Address - City:TWIN FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83301-4270
Mailing Address - Country:US
Mailing Address - Phone:208-814-8600
Mailing Address - Fax:208-814-8942
Practice Address - Street 1:625 POLE LINE RD W STE 2A
Practice Address - Street 2:
Practice Address - City:TWIN FALLS
Practice Address - State:ID
Practice Address - Zip Code:83301-4270
Practice Address - Country:US
Practice Address - Phone:208-814-8600
Practice Address - Fax:208-814-8942
Is Sole Proprietor?:No
Enumeration Date:2023-08-24
Last Update Date:2023-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
ID77909363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program