Provider Demographics
NPI:1710562350
Name:MULLIN, KAITLYN TAYLOR (MD)
Entity Type:Individual
Prefix:DR
First Name:KAITLYN
Middle Name:TAYLOR
Last Name:MULLIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MISS
Other - First Name:KAITLYN
Other - Middle Name:TAYLOR
Other - Last Name:WADE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3551 ROGER BROOKE DR
Mailing Address - Street 2:
Mailing Address - City:JBSA FT SAM HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:78234-4504
Mailing Address - Country:US
Mailing Address - Phone:210-916-9928
Mailing Address - Fax:210-916-9332
Practice Address - Street 1:3551 ROGER BROOKE DR
Practice Address - Street 2:
Practice Address - City:JBSA FT SAM HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:78234-4504
Practice Address - Country:US
Practice Address - Phone:210-916-9928
Practice Address - Fax:210-916-9332
Is Sole Proprietor?:No
Enumeration Date:2021-03-15
Last Update Date:2023-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101275952208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice