Provider Demographics
NPI:1437771607
Name:SHONNARD, KAITLIN RACHAEL (PA-C)
Entity Type:Individual
Prefix:
First Name:KAITLIN
Middle Name:RACHAEL
Last Name:SHONNARD
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 746873
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-6873
Mailing Address - Country:US
Mailing Address - Phone:312-733-9730
Mailing Address - Fax:
Practice Address - Street 1:2933 LAKEWOOD VILLAGE DR
Practice Address - Street 2:
Practice Address - City:NORTH LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72116-8033
Practice Address - Country:US
Practice Address - Phone:501-435-1417
Practice Address - Fax:501-232-2116
Is Sole Proprietor?:No
Enumeration Date:2020-05-11
Last Update Date:2023-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVPA2521363AM0700X
ARPA-1198363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical