Provider Demographics
NPI:1952186231
Name:WHITE, KAITLIN (FNP-C)
Entity Type:Individual
Prefix:
First Name:KAITLIN
Middle Name:
Last Name:WHITE
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18902 BROOKWOOD FRST
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78258-4457
Mailing Address - Country:US
Mailing Address - Phone:919-699-7733
Mailing Address - Fax:
Practice Address - Street 1:502 MADISON OAK DR STE 245
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78258-4086
Practice Address - Country:US
Practice Address - Phone:210-404-2532
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-25
Last Update Date:2023-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1016745363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner