Provider Demographics
NPI:1699389759
Name:CARON, KAITLYN (MSN, FNP-BC)
Entity Type:Individual
Prefix:
First Name:KAITLYN
Middle Name:
Last Name:CARON
Suffix:
Gender:F
Credentials:MSN, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1832 HARPER RD
Mailing Address - Street 2:
Mailing Address - City:BECKLEY
Mailing Address - State:WV
Mailing Address - Zip Code:25801-3366
Mailing Address - Country:US
Mailing Address - Phone:681-207-7130
Mailing Address - Fax:681-207-7132
Practice Address - Street 1:1832 HARPER RD
Practice Address - Street 2:
Practice Address - City:BECKLEY
Practice Address - State:WV
Practice Address - Zip Code:25801-3366
Practice Address - Country:US
Practice Address - Phone:681-207-7130
Practice Address - Fax:681-207-7132
Is Sole Proprietor?:No
Enumeration Date:2020-09-04
Last Update Date:2022-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVAPRN107400363L00000X
WVAPRN94455363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
WVAPRN107400OtherWV BOARD OF REGISTERED NURSES FNP LICENSE NUMBER