Provider Demographics
NPI:1932540705
Name:WARREN, KAITLIN (CPNP)
Entity Type:Individual
Prefix:
First Name:KAITLIN
Middle Name:
Last Name:WARREN
Suffix:
Gender:F
Credentials:CPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1102 BLACK PINE LN
Mailing Address - Street 2:
Mailing Address - City:PLEASANT HILL
Mailing Address - State:CA
Mailing Address - Zip Code:94523-2561
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2299 BACON ST
Practice Address - Street 2:SUITE 7
Practice Address - City:CONCORD
Practice Address - State:CA
Practice Address - Zip Code:94520-2050
Practice Address - Country:US
Practice Address - Phone:925-676-6500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-09
Last Update Date:2015-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY657699-1163W00000X
NY382428363LP0200X
CA95000795363LP0200X
CA95032461163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No163W00000XNursing Service ProvidersRegistered Nurse