Provider Demographics
NPI:1508611260
Name:MARTELL, KAITLEN HENNESSEY (PA-C)
Entity Type:Individual
Prefix:
First Name:KAITLEN
Middle Name:HENNESSEY
Last Name:MARTELL
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:KAITLEN
Other - Middle Name:MARY
Other - Last Name:HENNESSEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5518 ATLANTIC AVE APT 208
Mailing Address - Street 2:
Mailing Address - City:DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33484-8595
Mailing Address - Country:US
Mailing Address - Phone:954-495-7856
Mailing Address - Fax:
Practice Address - Street 1:5518 ATLANTIC AVE APT 208
Practice Address - Street 2:
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33484-8595
Practice Address - Country:US
Practice Address - Phone:954-495-7856
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-17
Last Update Date:2024-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9118734363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant