Provider Demographics
NPI:1780143297
Name:AVERETT, KAITLYN ANNE (FNPC)
Entity type:Individual
Prefix:
First Name:KAITLYN
Middle Name:ANNE
Last Name:AVERETT
Suffix:
Gender:F
Credentials:FNPC
Other - Prefix:
Other - First Name:KAITLYN
Other - Middle Name:ANNE
Other - Last Name:KELLY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APN
Mailing Address - Street 1:PO BOX 689
Mailing Address - Street 2:
Mailing Address - City:WAYNESBORO
Mailing Address - State:TN
Mailing Address - Zip Code:38485-0689
Mailing Address - Country:US
Mailing Address - Phone:931-722-2800
Mailing Address - Fax:931-722-9627
Practice Address - Street 1:107 JV MANGUBAT DR
Practice Address - Street 2:
Practice Address - City:WAYNESBORO
Practice Address - State:TN
Practice Address - Zip Code:38485-2440
Practice Address - Country:US
Practice Address - Phone:931-722-2800
Practice Address - Fax:931-722-9627
Is Sole Proprietor?:No
Enumeration Date:2019-03-14
Last Update Date:2021-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN25512363LP2300X
TN25512363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care