Provider Demographics
NPI:1285136515
Name:WERT, KAITLIN DOLORES (NP-C)
Entity type:Individual
Prefix:
First Name:KAITLIN
Middle Name:DOLORES
Last Name:WERT
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:KAITLIN
Other - Middle Name:DOLORES
Other - Last Name:MAIOLI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:27 TALISMAN DR STE 3
Mailing Address - Street 2:
Mailing Address - City:PAGOSA SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:81147-9377
Mailing Address - Country:US
Mailing Address - Phone:406-570-7921
Mailing Address - Fax:
Practice Address - Street 1:27B TALISMAN DR UNIT 3
Practice Address - Street 2:
Practice Address - City:PAGOSA SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:81147-7914
Practice Address - Country:US
Practice Address - Phone:970-372-0456
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-02
Last Update Date:2018-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COC-APN.0000969-C-NP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily