Provider Demographics
NPI:1194284786
Name:DUNBAR, KAITLYN KISS (PA-C)
Entity type:Individual
Prefix:MS
First Name:KAITLYN
Middle Name:KISS
Last Name:DUNBAR
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MS
Other - First Name:KAITLYN
Other - Middle Name:VICTORIA
Other - Last Name:KISS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:60 COLUMBIA ST STE 400
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32806-1115
Mailing Address - Country:US
Mailing Address - Phone:321-843-5851
Mailing Address - Fax:321-841-7727
Practice Address - Street 1:60 COLUMBIA ST STE 400
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32806-1115
Practice Address - Country:US
Practice Address - Phone:321-843-5851
Practice Address - Fax:321-841-7727
Is Sole Proprietor?:No
Enumeration Date:2019-03-14
Last Update Date:2025-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9114816363A00000X, 363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL12133700Medicaid