Provider Demographics
NPI:1386368355
Name:BROWN, KAITLIN MARIE (RN)
Entity type:Individual
Prefix:
First Name:KAITLIN
Middle Name:MARIE
Last Name:BROWN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:7850 LAUREL DALE ROAD
Mailing Address - Street 2:
Mailing Address - City:NEW CREEK
Mailing Address - State:WV
Mailing Address - Zip Code:26743
Mailing Address - Country:US
Mailing Address - Phone:304-790-3433
Mailing Address - Fax:
Practice Address - Street 1:100 HOSPITAL DR STE 3
Practice Address - Street 2:
Practice Address - City:PETERSBURG
Practice Address - State:WV
Practice Address - Zip Code:26847-9570
Practice Address - Country:US
Practice Address - Phone:304-257-1015
Practice Address - Fax:304-257-1129
Is Sole Proprietor?:No
Enumeration Date:2022-10-03
Last Update Date:2022-10-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WV002401225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant