Provider Demographics
NPI:1316706922
Name:WANG, KAIDI (APRN)
Entity type:Individual
Prefix:MS
First Name:KAIDI
Middle Name:
Last Name:WANG
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11717 TROTTINGHAM CIR
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40299-3538
Mailing Address - Country:US
Mailing Address - Phone:602-881-4363
Mailing Address - Fax:
Practice Address - Street 1:11717 TROTTINGHAM CIR
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40299-3538
Practice Address - Country:US
Practice Address - Phone:602-881-4363
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-18
Last Update Date:2024-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY4017280363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care