Provider Demographics
NPI:1417564485
Name:LOVELESS, KAITLIN (APRN)
Entity Type:Individual
Prefix:
First Name:KAITLIN
Middle Name:
Last Name:LOVELESS
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 1:117 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:KY
Mailing Address - Zip Code:42078-9998
Mailing Address - Country:US
Mailing Address - Phone:270-988-3839
Mailing Address - Fax:270-988-3832
Practice Address - Street 1:117 E MAIN ST
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:KY
Practice Address - Zip Code:42078-9998
Practice Address - Country:US
Practice Address - Phone:270-988-3839
Practice Address - Fax:270-988-3832
Is Sole Proprietor?:No
Enumeration Date:2020-09-24
Last Update Date:2020-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3015168363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health