Provider Demographics
NPI:1427634583
Name:MASHBURN, KAITLYN BROOKE (NP)
Entity type:Individual
Prefix:
First Name:KAITLYN
Middle Name:BROOKE
Last Name:MASHBURN
Suffix:
Gender:
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5808 PAINE RD
Mailing Address - Street 2:
Mailing Address - City:COOKEVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38501-7252
Mailing Address - Country:US
Mailing Address - Phone:931-644-9220
Mailing Address - Fax:
Practice Address - Street 1:1080 NEAL ST STE 300
Practice Address - Street 2:
Practice Address - City:COOKEVILLE
Practice Address - State:TN
Practice Address - Zip Code:38501-0945
Practice Address - Country:US
Practice Address - Phone:931-854-1391
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-19
Last Update Date:2025-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN29199363L00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN29199OtherAPRN LICENSE