Provider Demographics
NPI:1902549603
Name:WHITE, KAYTLIN SHANEL
Entity Type:Individual
Prefix:
First Name:KAYTLIN
Middle Name:SHANEL
Last Name:WHITE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3200 MESA WAY STE D
Mailing Address - Street 2:
Mailing Address - City:LAWRENCE
Mailing Address - State:KS
Mailing Address - Zip Code:66049-2343
Mailing Address - Country:US
Mailing Address - Phone:785-831-3053
Mailing Address - Fax:
Practice Address - Street 1:3200 MESA WAY STE D
Practice Address - Street 2:
Practice Address - City:LAWRENCE
Practice Address - State:KS
Practice Address - Zip Code:66049-2343
Practice Address - Country:US
Practice Address - Phone:785-831-3053
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-19
Last Update Date:2022-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program