Provider Demographics
NPI:1831569045
Name:REYES, KAITLEN ANNE (DNP, FNP, RN)
Entity type:Individual
Prefix:DR
First Name:KAITLEN
Middle Name:ANNE
Last Name:REYES
Suffix:
Gender:F
Credentials:DNP, FNP, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:83 ATHELSTANE RD
Mailing Address - Street 2:
Mailing Address - City:NEWTON CENTER
Mailing Address - State:MA
Mailing Address - Zip Code:02459-2422
Mailing Address - Country:US
Mailing Address - Phone:818-624-5841
Mailing Address - Fax:
Practice Address - Street 1:83 ATHELSTANE RD
Practice Address - Street 2:
Practice Address - City:NEWTON CENTER
Practice Address - State:MA
Practice Address - Zip Code:02459-2422
Practice Address - Country:US
Practice Address - Phone:818-624-5841
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-09-30
Last Update Date:2015-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2281789163W00000X
MAF07151433363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse