Provider Demographics
NPI:1912605098
Name:NISBY, KAITLYN
Entity Type:Individual
Prefix:MS
First Name:KAITLYN
Middle Name:
Last Name:NISBY
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 1:7202 BARKER CYPRESS RD APT 11202
Mailing Address - Street 2:
Mailing Address - City:CYPRESS
Mailing Address - State:TX
Mailing Address - Zip Code:77433-2928
Mailing Address - Country:US
Mailing Address - Phone:985-360-9794
Mailing Address - Fax:
Practice Address - Street 1:7202 BARKER CYPRESS RD APT 11202
Practice Address - Street 2:
Practice Address - City:CYPRESS
Practice Address - State:TX
Practice Address - Zip Code:77433-2928
Practice Address - Country:US
Practice Address - Phone:985-360-9794
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-20
Last Update Date:2023-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator