Provider Demographics
NPI:1104440619
Name:WOOD, KAITLIN ELIZABETH (PA-C)
Entity type:Individual
Prefix:MISS
First Name:KAITLIN
Middle Name:ELIZABETH
Last Name:WOOD
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2900 S TELEPHONE RD STE 250
Mailing Address - Street 2:
Mailing Address - City:MOORE
Mailing Address - State:OK
Mailing Address - Zip Code:73160-2969
Mailing Address - Country:US
Mailing Address - Phone:405-237-7500
Mailing Address - Fax:
Practice Address - Street 1:2900 S TELEPHONE RD STE 250
Practice Address - Street 2:
Practice Address - City:MOORE
Practice Address - State:OK
Practice Address - Zip Code:73160-2969
Practice Address - Country:US
Practice Address - Phone:405-237-7500
Practice Address - Fax:405-237-7512
Is Sole Proprietor?:No
Enumeration Date:2020-05-31
Last Update Date:2024-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant