Provider Demographics
NPI:1710459706
Name:EARLS, KAITLYNN (PMHNP-BC)
Entity Type:Individual
Prefix:MRS
First Name:KAITLYNN
Middle Name:
Last Name:EARLS
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:MISS
Other - First Name:KAITLYNN
Other - Middle Name:
Other - Last Name:PUCKETT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:1167 SPRATLIN PARK DR
Mailing Address - Street 2:
Mailing Address - City:GRAY
Mailing Address - State:TN
Mailing Address - Zip Code:37615-6205
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:401 HOLSTON DR
Practice Address - Street 2:
Practice Address - City:GREENEVILLE
Practice Address - State:TN
Practice Address - Zip Code:37743-3127
Practice Address - Country:US
Practice Address - Phone:423-639-1104
Practice Address - Fax:423-467-3644
Is Sole Proprietor?:No
Enumeration Date:2019-01-02
Last Update Date:2020-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN26158363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health