Provider Demographics
NPI:1396412391
Name:LANDIS, KAITLYN SARAYA (PA-C)
Entity type:Individual
Prefix:MRS
First Name:KAITLYN
Middle Name:SARAYA
Last Name:LANDIS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MISS
Other - First Name:KAITLYN
Other - Middle Name:SARAYA
Other - Last Name:SHOEMAKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:103 W BROADWAY AVE
Mailing Address - Street 2:
Mailing Address - City:MARYVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37801-4703
Mailing Address - Country:US
Mailing Address - Phone:865-273-1752
Mailing Address - Fax:865-273-1755
Practice Address - Street 1:1450 DOWELL SPRINGS BLVD STE 300
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37909-2444
Practice Address - Country:US
Practice Address - Phone:865-637-8812
Practice Address - Fax:865-637-8865
Is Sole Proprietor?:No
Enumeration Date:2021-08-26
Last Update Date:2025-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN363AM0700X
TN4732363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical