Provider Demographics
NPI:1588033070
Name:CLEETER, KAITLIN KINNEY (MSN, RN, CPNP-PC)
Entity Type:Individual
Prefix:MRS
First Name:KAITLIN
Middle Name:KINNEY
Last Name:CLEETER
Suffix:
Gender:F
Credentials:MSN, RN, CPNP-PC
Other - Prefix:MRS
Other - First Name:KAITLIN
Other - Middle Name:
Other - Last Name:KINNEY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MSN, RN, CPNP-PC
Mailing Address - Street 1:862 W RUSK ST
Mailing Address - Street 2:
Mailing Address - City:ROCKWALL
Mailing Address - State:TX
Mailing Address - Zip Code:75087-3421
Mailing Address - Country:US
Mailing Address - Phone:972-412-3034
Mailing Address - Fax:972-412-3695
Practice Address - Street 1:862 W RUSK ST
Practice Address - Street 2:
Practice Address - City:ROCKWALL
Practice Address - State:TX
Practice Address - Zip Code:75087-3421
Practice Address - Country:US
Practice Address - Phone:972-412-3034
Practice Address - Fax:972-412-3695
Is Sole Proprietor?:No
Enumeration Date:2015-09-15
Last Update Date:2023-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP129040363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics