Provider Demographics
NPI:1346645595
Name:ANDERSON, KAITLIN REISS (DNP, CPNP)
Entity Type:Individual
Prefix:
First Name:KAITLIN
Middle Name:REISS
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:DNP, CPNP
Other - Prefix:
Other - First Name:KAITLIN
Other - Middle Name:ELIZABETH
Other - Last Name:REISS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:7700 MORRO RD
Mailing Address - Street 2:
Mailing Address - City:ATASCADERO
Mailing Address - State:CA
Mailing Address - Zip Code:93422-4435
Mailing Address - Country:US
Mailing Address - Phone:805-466-6622
Mailing Address - Fax:
Practice Address - Street 1:7700 MORRO RD
Practice Address - Street 2:
Practice Address - City:ATASCADERO
Practice Address - State:CA
Practice Address - Zip Code:93422-4435
Practice Address - Country:US
Practice Address - Phone:805-466-6622
Practice Address - Fax:805-461-0361
Is Sole Proprietor?:No
Enumeration Date:2014-10-30
Last Update Date:2021-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC225342163W00000X
SC21374363LP0200X
CA95012201363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No163W00000XNursing Service ProvidersRegistered Nurse