Provider Demographics
NPI:1295586345
Name:ROSE, KAITLYN (ACNPC-AG)
Entity type:Individual
Prefix:
First Name:KAITLYN
Middle Name:
Last Name:ROSE
Suffix:
Gender:F
Credentials:ACNPC-AG
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7240 COUNTY ROAD 410
Mailing Address - Street 2:
Mailing Address - City:MCKINNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75071-0548
Mailing Address - Country:US
Mailing Address - Phone:903-267-4176
Mailing Address - Fax:
Practice Address - Street 1:7240 COUNTY ROAD 410
Practice Address - Street 2:
Practice Address - City:MCKINNEY
Practice Address - State:TX
Practice Address - Zip Code:75071-0548
Practice Address - Country:US
Practice Address - Phone:903-267-4176
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-28
Last Update Date:2024-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1156111208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery