Provider Demographics
NPI:1215459359
Name:SHUSTER, KAITLAND NICOLE (CRNP)
Entity type:Individual
Prefix:MRS
First Name:KAITLAND
Middle Name:NICOLE
Last Name:SHUSTER
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:555 W NEWTON ST
Mailing Address - Street 2:
Mailing Address - City:GREENSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:15601-2861
Mailing Address - Country:US
Mailing Address - Phone:724-832-7045
Mailing Address - Fax:
Practice Address - Street 1:25 N THOMPSON LN STE E
Practice Address - Street 2:
Practice Address - City:NORTH HUNTINGDON
Practice Address - State:PA
Practice Address - Zip Code:15642-9305
Practice Address - Country:US
Practice Address - Phone:724-382-4941
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-11
Last Update Date:2025-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP017829363L00000X
PARN655082363LF0000X
PASP027687363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA002023534OtherHIGHMARK BLUE SHIELD
PA0015083500027Medicaid
PACI6140OtherRAILROAD MEDICARE
PA710929OtherMEDICARE