Provider Demographics
NPI:1700613429
Name:ZALUNARDO, KAITLIN SMITH (RN)
Entity type:Individual
Prefix:
First Name:KAITLIN
Middle Name:SMITH
Last Name:ZALUNARDO
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1791 OG SKINNER DR STE C
Mailing Address - Street 2:
Mailing Address - City:WEST POINT
Mailing Address - State:GA
Mailing Address - Zip Code:31833-1900
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1791 OG SKINNER DR STE C
Practice Address - Street 2:
Practice Address - City:WEST POINT
Practice Address - State:GA
Practice Address - Zip Code:31833-1900
Practice Address - Country:US
Practice Address - Phone:706-629-0161
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-17
Last Update Date:2024-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL41314508163W00000X
TN85968164W00000X
TX194440164X00000X
FLTT16074227800000X
GARN277731163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No164W00000XNursing Service ProvidersLicensed Practical Nurse
No164X00000XNursing Service ProvidersLicensed Vocational Nurse
No227800000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, Certified