Provider Demographics
NPI:1760364434
Name:SOLOMON, KAITLYN MARIE (AGPCNP)
Entity type:Individual
Prefix:
First Name:KAITLYN
Middle Name:MARIE
Last Name:SOLOMON
Suffix:
Gender:F
Credentials:AGPCNP
Other - Prefix:
Other - First Name:KAITLYN
Other - Middle Name:MARIE
Other - Last Name:MEZINIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:PO BOX 419052
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63141-9052
Mailing Address - Country:US
Mailing Address - Phone:314-851-1000
Mailing Address - Fax:314-851-4477
Practice Address - Street 1:714 GRAVOIS RD STE 210
Practice Address - Street 2:
Practice Address - City:FENTON
Practice Address - State:MO
Practice Address - Zip Code:63026-7723
Practice Address - Country:US
Practice Address - Phone:636-660-9850
Practice Address - Fax:636-660-9851
Is Sole Proprietor?:No
Enumeration Date:2025-07-23
Last Update Date:2025-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2003009200363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology