Provider Demographics
NPI:1720759400
Name:WHEELAN, KAITLYN K
Entity Type:Individual
Prefix:
First Name:KAITLYN
Middle Name:K
Last Name:WHEELAN
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 1:1100 5TH ST STE 210
Mailing Address - Street 2:
Mailing Address - City:CORALVILLE
Mailing Address - State:IA
Mailing Address - Zip Code:52241-2934
Mailing Address - Country:US
Mailing Address - Phone:319-594-5953
Mailing Address - Fax:
Practice Address - Street 1:1100 5TH ST STE 210
Practice Address - Street 2:
Practice Address - City:CORALVILLE
Practice Address - State:IA
Practice Address - Zip Code:52241-2934
Practice Address - Country:US
Practice Address - Phone:319-594-5953
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-23
Last Update Date:2021-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAH165786363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner