Provider Demographics
NPI:1376270918
Name:SHORT, KAITLYN S (APRN)
Entity Type:Individual
Prefix:
First Name:KAITLYN
Middle Name:S
Last Name:SHORT
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:421 E 30TH AVE
Mailing Address - Street 2:
Mailing Address - City:HUTCHINSON
Mailing Address - State:KS
Mailing Address - Zip Code:67502-2412
Mailing Address - Country:US
Mailing Address - Phone:620-663-2678
Mailing Address - Fax:866-557-4375
Practice Address - Street 1:421 E 30TH AVE
Practice Address - Street 2:
Practice Address - City:HUTCHINSON
Practice Address - State:KS
Practice Address - Zip Code:67502-2412
Practice Address - Country:US
Practice Address - Phone:620-663-2678
Practice Address - Fax:866-557-4375
Is Sole Proprietor?:No
Enumeration Date:2022-08-03
Last Update Date:2022-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS80950363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily