Provider Demographics
NPI:1326545336
Name:LUCAS, KAITLYN M (APRN)
Entity Type:Individual
Prefix:
First Name:KAITLYN
Middle Name:M
Last Name:LUCAS
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:KAITLYN
Other - Middle Name:M
Other - Last Name:BURTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:2424 N WYATT DR STE 260
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85712-6118
Mailing Address - Country:US
Mailing Address - Phone:520-795-0608
Mailing Address - Fax:520-795-0354
Practice Address - Street 1:6261 N LA CHOLLA BLVD STE 277
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85741-3564
Practice Address - Country:US
Practice Address - Phone:520-877-3800
Practice Address - Fax:520-877-3801
Is Sole Proprietor?:No
Enumeration Date:2018-04-07
Last Update Date:2024-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK10683163W00000X
OK106803363LF0000X
AZ251532363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse