Provider Demographics
NPI:1497531453
Name:WOOD, KAITLYN (RN)
Entity Type:Individual
Prefix:MRS
First Name:KAITLYN
Middle Name:
Last Name:WOOD
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MS
Other - First Name:KAITLYN
Other - Middle Name:
Other - Last Name:THIBODEAU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:91 FIDDLERS LN
Mailing Address - Street 2:
Mailing Address - City:LATHAM
Mailing Address - State:NY
Mailing Address - Zip Code:12110-5343
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:91 FIDDLERS LN
Practice Address - Street 2:
Practice Address - City:LATHAM
Practice Address - State:NY
Practice Address - Zip Code:12110-5343
Practice Address - Country:US
Practice Address - Phone:518-785-8591
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-06
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY673597163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03052893Medicaid