Provider Demographics
NPI:1477205409
Name:SCOTT, KAITLIN STUTTS (PA-C)
Entity Type:Individual
Prefix:
First Name:KAITLIN
Middle Name:STUTTS
Last Name:SCOTT
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:KAITLIN
Other - Middle Name:TAYLOR
Other - Last Name:STUTTS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2100 FRANKLIN ST STE 355
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94612-3140
Mailing Address - Country:US
Mailing Address - Phone:844-234-7741
Mailing Address - Fax:
Practice Address - Street 1:1218 W IRVINGTON RD STE 150
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85714-1137
Practice Address - Country:US
Practice Address - Phone:520-829-6442
Practice Address - Fax:888-972-1912
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-20
Last Update Date:2024-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ9996363A00000X
363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Single Specialty
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedicalGroup - Single Specialty