Provider Demographics
NPI:1629955760
Name:STARRS, KAITLYN CRYSTAL
Entity type:Individual
Prefix:
First Name:KAITLYN
Middle Name:CRYSTAL
Last Name:STARRS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KAITLYN
Other - Middle Name:CRYSTAL
Other - Last Name:PROSCHOLD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNP
Mailing Address - Street 1:40 MATTHEW CT
Mailing Address - Street 2:
Mailing Address - City:LITTLESTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:17340-9190
Mailing Address - Country:US
Mailing Address - Phone:717-202-9177
Mailing Address - Fax:
Practice Address - Street 1:SHEPHERD UNIVERSITY
Practice Address - Street 2:301 N. KING ST.
Practice Address - City:SHEPHERDSTOWN
Practice Address - State:WV
Practice Address - Zip Code:17340
Practice Address - Country:US
Practice Address - Phone:717-202-9177
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-20
Last Update Date:2025-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP022097208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics