Provider Demographics
NPI:1922780972
Name:MCTIGUE, KAITLYN KELLY (NP)
Entity Type:Individual
Prefix:
First Name:KAITLYN
Middle Name:KELLY
Last Name:MCTIGUE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:KAITLYN
Other - Middle Name:ELIZABETH
Other - Last Name:KELLY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:78 BADGER CIR
Mailing Address - Street 2:
Mailing Address - City:MILTON
Mailing Address - State:MA
Mailing Address - Zip Code:02186-4022
Mailing Address - Country:US
Mailing Address - Phone:781-724-2584
Mailing Address - Fax:
Practice Address - Street 1:78 BADGER CIR
Practice Address - Street 2:
Practice Address - City:MILTON
Practice Address - State:MA
Practice Address - Zip Code:02186-4022
Practice Address - Country:US
Practice Address - Phone:781-724-2584
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-01
Last Update Date:2023-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2311960363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health