Provider Demographics
NPI:1750976619
Name:MASON, KAITLYN
Entity type:Individual
Prefix:
First Name:KAITLYN
Middle Name:
Last Name:MASON
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 1:303 E MATTHEWS AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:AR
Mailing Address - Zip Code:72401-3113
Mailing Address - Country:US
Mailing Address - Phone:870-207-6309
Mailing Address - Fax:
Practice Address - Street 1:303 E MATTHEWS AVE STE 100
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:AR
Practice Address - Zip Code:72401-3113
Practice Address - Country:US
Practice Address - Phone:870-207-6309
Practice Address - Fax:870-207-6309
Is Sole Proprietor?:No
Enumeration Date:2021-03-03
Last Update Date:2025-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARR100263163WC0200X
AR216188363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine