Provider Demographics
NPI:1851712442
Name:WHITE, KAITLYN ELISABETH (PA-C)
Entity Type:Individual
Prefix:
First Name:KAITLYN
Middle Name:ELISABETH
Last Name:WHITE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:KAITLYN
Other - Middle Name:ELISABETH
Other - Last Name:MCGUINN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PA-C
Mailing Address - Street 1:2550 N THUNDERBIRD CIR STE 303
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85215-1219
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:480-776-0025
Practice Address - Street 1:7227 PRESTON RD
Practice Address - Street 2:
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75034-5617
Practice Address - Country:US
Practice Address - Phone:972-377-7878
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-12-26
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPA.0003891363A00000X
TXPA10447363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO22925341Medicaid
CO372070YL2GMedicare PIN