Provider Demographics
NPI:1740831502
Name:PREBLE, KAITLYN THUMANN (PA-C)
Entity type:Individual
Prefix:MRS
First Name:KAITLYN
Middle Name:THUMANN
Last Name:PREBLE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5019 PORTICO WAY
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:TX
Mailing Address - Zip Code:79707-3102
Mailing Address - Country:US
Mailing Address - Phone:432-242-0540
Mailing Address - Fax:
Practice Address - Street 1:5019 PORTICO WAY
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:TX
Practice Address - Zip Code:79707-3102
Practice Address - Country:US
Practice Address - Phone:432-242-0540
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-24
Last Update Date:2023-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant