Provider Demographics
NPI:1659079358
Name:ZULETA, KAITLIN GILLESPIE (DNP, AGNP,)
Entity Type:Individual
Prefix:MRS
First Name:KAITLIN
Middle Name:GILLESPIE
Last Name:ZULETA
Suffix:
Gender:F
Credentials:DNP, AGNP,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:930 THIRD ST
Mailing Address - Street 2:STE 236
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27405-6967
Mailing Address - Country:US
Mailing Address - Phone:336-890-3301
Mailing Address - Fax:
Practice Address - Street 1:930 THIRD ST
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27405-6967
Practice Address - Country:US
Practice Address - Phone:336-890-3277
Practice Address - Fax:336-365-7546
Is Sole Proprietor?:No
Enumeration Date:2023-02-21
Last Update Date:2023-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC301297163W00000X
NC5018456363L00000X, 363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No163W00000XNursing Service ProvidersRegistered Nurse
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner