Provider Demographics
NPI:1700697885
Name:STEWART, KAITLIN DEVON (FNP-BC)
Entity type:Individual
Prefix:
First Name:KAITLIN
Middle Name:DEVON
Last Name:STEWART
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:688 OLD COLCHESTER RD APT 14
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:CT
Mailing Address - Zip Code:06420-3740
Mailing Address - Country:US
Mailing Address - Phone:860-859-7884
Mailing Address - Fax:
Practice Address - Street 1:688 OLD COLCHESTER RD APT 14
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:CT
Practice Address - Zip Code:06420-3740
Practice Address - Country:US
Practice Address - Phone:860-859-7884
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-16
Last Update Date:2025-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT12.014329363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner