Provider Demographics
NPI:1558005140
Name:WISE, KAITLYN JANAE MCCOLLUM (MD)
Entity Type:Individual
Prefix:
First Name:KAITLYN
Middle Name:JANAE MCCOLLUM
Last Name:WISE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:KAITLYN
Other - Middle Name:JANAE
Other - Last Name:MCCOLLUM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2200 CHILDREN'S WAY
Mailing Address - Street 2:8232 DOT
Mailing Address - City:NASVHILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37232
Mailing Address - Country:US
Mailing Address - Phone:615-936-2555
Mailing Address - Fax:
Practice Address - Street 1:2200 CHILDREN'S WAY
Practice Address - Street 2:8232 DOT
Practice Address - City:NASVHILLE
Practice Address - State:TN
Practice Address - Zip Code:37232
Practice Address - Country:US
Practice Address - Phone:615-936-2555
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-21
Last Update Date:2022-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program