Provider Demographics
NPI:1619485703
Name:CARTER, KAITLIN TAYLOR (PA)
Entity type:Individual
Prefix:
First Name:KAITLIN
Middle Name:TAYLOR
Last Name:CARTER
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:KAITLIN
Other - Middle Name:TAYLOR
Other - Last Name:MEADE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:200 CORPORATE BLVD
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70508-3870
Mailing Address - Country:US
Mailing Address - Phone:800-893-9698
Mailing Address - Fax:
Practice Address - Street 1:30461 GARNAND DRIVE
Practice Address - Street 2:EMORY & HENRY COLLEGE
Practice Address - City:EMORY
Practice Address - State:VA
Practice Address - Zip Code:24327
Practice Address - Country:US
Practice Address - Phone:276-944-6500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-11
Last Update Date:2024-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer