Provider Demographics
NPI:1417416470
Name:MOLINA, KAITLYN PARKER (DO)
Entity Type:Individual
Prefix:
First Name:KAITLYN
Middle Name:PARKER
Last Name:MOLINA
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:KAITLYN
Other - Middle Name:ANN
Other - Last Name:PARKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:4501 N DAVIS HWY STE C
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32503-2724
Mailing Address - Country:US
Mailing Address - Phone:850-416-4960
Mailing Address - Fax:850-416-4961
Practice Address - Street 1:4501 N DAVIS HWY STE C
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32503-2724
Practice Address - Country:US
Practice Address - Phone:850-416-4960
Practice Address - Fax:850-416-4961
Is Sole Proprietor?:No
Enumeration Date:2019-03-18
Last Update Date:2024-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS18844207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine