Individual
KAITLAND ARD
Active
Individual
KAITLAND ARD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PA-C
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
4789
CT
363A00000X
Physician Assistant
PA.0007035
CO
363AM0700X
Medical Physician Assistant
Primary
004789
CT
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
12/04/2019
Last updated
11/16/2021
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