Provider Demographics
NPI:1093210429
Name:WERNER, KAITLYN SMITH (MD)
Entity Type:Individual
Prefix:
First Name:KAITLYN
Middle Name:SMITH
Last Name:WERNER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:695 33RD ST SE
Mailing Address - Street 2:
Mailing Address - City:PARIS
Mailing Address - State:TX
Mailing Address - Zip Code:75460-6561
Mailing Address - Country:US
Mailing Address - Phone:580-298-7703
Mailing Address - Fax:
Practice Address - Street 1:1055 CLARKSVILLE ST STE 195
Practice Address - Street 2:
Practice Address - City:PARIS
Practice Address - State:TX
Practice Address - Zip Code:75460-6087
Practice Address - Country:US
Practice Address - Phone:903-785-8480
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-27
Last Update Date:2021-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
TXT2289207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program