Provider Demographics
NPI:1457884231
Name:WALLS, KAITLIN (APRN)
Entity Type:Individual
Prefix:
First Name:KAITLIN
Middle Name:
Last Name:WALLS
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2675 WINKLER AVE FL 2
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33901-9342
Mailing Address - Country:US
Mailing Address - Phone:877-856-3774
Mailing Address - Fax:239-599-2612
Practice Address - Street 1:11181 HEALTH PARK BLVD STE 3010
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34110-5743
Practice Address - Country:US
Practice Address - Phone:239-302-3290
Practice Address - Fax:239-302-3291
Is Sole Proprietor?:No
Enumeration Date:2017-04-07
Last Update Date:2021-06-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLARNP9327469364SF0001X
FLAPRN9327469363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No364SF0001XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistFamily Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLWXNEYOtherBCBS
FLIY345ZOtherMEDICARE