Provider Demographics
NPI:1699573535
Name:WOOD, KAITLYN (BSN, RN)
Entity type:Individual
Prefix:
First Name:KAITLYN
Middle Name:
Last Name:WOOD
Suffix:
Gender:
Credentials:BSN, RN
Other - Prefix:
Other - First Name:KAITLYN
Other - Middle Name:
Other - Last Name:BOUCHER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:222 W 3RD ST
Mailing Address - Street 2:
Mailing Address - City:PORT ANGELES
Mailing Address - State:WA
Mailing Address - Zip Code:98362-2827
Mailing Address - Country:US
Mailing Address - Phone:701-208-0104
Mailing Address - Fax:
Practice Address - Street 1:939 CAROLINE ST
Practice Address - Street 2:
Practice Address - City:PORT ANGELES
Practice Address - State:WA
Practice Address - Zip Code:98362-3997
Practice Address - Country:US
Practice Address - Phone:360-417-7000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-06
Last Update Date:2025-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN61425648163WE0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WE0003XNursing Service ProvidersRegistered NurseEmergency