Provider Demographics
NPI:1750827077
Name:SPRADLING, KAITLYN LEIGH
Entity Type:Individual
Prefix:MS
First Name:KAITLYN
Middle Name:LEIGH
Last Name:SPRADLING
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1460 W VALENCIA RD
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85746-6001
Mailing Address - Country:US
Mailing Address - Phone:520-573-0966
Mailing Address - Fax:520-257-4334
Practice Address - Street 1:1460 W VALENCIA RD
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85746-6001
Practice Address - Country:US
Practice Address - Phone:520-573-0966
Practice Address - Fax:520-573-3930
Is Sole Proprietor?:No
Enumeration Date:2017-01-10
Last Update Date:2018-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP9705363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ1750827077Medicaid