Provider Demographics
NPI:1851712442
Name:WHITE, KAITLYN ELISABETH (PA-C)
Entity type:Individual
Prefix:
First Name:KAITLYN
Middle Name:ELISABETH
Last Name:WHITE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:KAITLYN
Other - Middle Name:ELISABETH
Other - Last Name:MCGUINN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PA-C
Mailing Address - Street 1:834 S PERRY ST STE F620
Mailing Address - Street 2:
Mailing Address - City:CASTLE ROCK
Mailing Address - State:CO
Mailing Address - Zip Code:80104-1918
Mailing Address - Country:US
Mailing Address - Phone:720-823-7110
Mailing Address - Fax:720-823-3551
Practice Address - Street 1:115 WILCOX ST STE 220
Practice Address - Street 2:
Practice Address - City:CASTLE ROCK
Practice Address - State:CO
Practice Address - Zip Code:80104-2049
Practice Address - Country:US
Practice Address - Phone:720-823-7110
Practice Address - Fax:720-823-3551
Is Sole Proprietor?:No
Enumeration Date:2013-12-26
Last Update Date:2024-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA10447363A00000X
COPA.0003891363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO22925341Medicaid
CO372070YL2GMedicare PIN