Provider Demographics
NPI:1467076687
Name:MARTIN, KAITLIN A (CNP)
Entity Type:Individual
Prefix:
First Name:KAITLIN
Middle Name:A
Last Name:MARTIN
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:211 EDGEFIELD BLVD
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:OH
Mailing Address - Zip Code:43302-5801
Mailing Address - Country:US
Mailing Address - Phone:740-914-4178
Mailing Address - Fax:740-386-2640
Practice Address - Street 1:1321 BELLEFONTAINE ST STE 100
Practice Address - Street 2:
Practice Address - City:WAPAKONETA
Practice Address - State:OH
Practice Address - Zip Code:45895-8769
Practice Address - Country:US
Practice Address - Phone:567-356-4054
Practice Address - Fax:567-356-4056
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-03
Last Update Date:2020-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.026557363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty