Provider Demographics
NPI:1720568462
Name:WEEKS, KAITLIN (PA)
Entity Type:Individual
Prefix:MS
First Name:KAITLIN
Middle Name:
Last Name:WEEKS
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:119 WHITE WATER DR
Mailing Address - Street 2:
Mailing Address - City:OCOEE
Mailing Address - State:TN
Mailing Address - Zip Code:37361-3645
Mailing Address - Country:US
Mailing Address - Phone:423-299-9435
Mailing Address - Fax:423-299-9436
Practice Address - Street 1:119 WHITE WATER DR
Practice Address - Street 2:
Practice Address - City:OCOEE
Practice Address - State:TN
Practice Address - Zip Code:37361-3645
Practice Address - Country:US
Practice Address - Phone:423-299-9435
Practice Address - Fax:423-299-9436
Is Sole Proprietor?:No
Enumeration Date:2018-08-21
Last Update Date:2020-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9111458363A00000X
TN3968363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant