Provider Demographics
NPI:1184460420
Name:CHAMPIE, KAITLIN J
Entity type:Individual
Prefix:
First Name:KAITLIN
Middle Name:J
Last Name:CHAMPIE
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 1:10185 GOLD MINE DR
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89521-4177
Mailing Address - Country:US
Mailing Address - Phone:775-224-9653
Mailing Address - Fax:
Practice Address - Street 1:1946 OLD HOT SPRINGS RD
Practice Address - Street 2:
Practice Address - City:CARSON CITY
Practice Address - State:NV
Practice Address - Zip Code:89706-0674
Practice Address - Country:US
Practice Address - Phone:775-882-1324
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-05
Last Update Date:2024-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV880170363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily