Provider Demographics
NPI:1780229955
Name:WATKINS, KAITLYN ANN (PA-C)
Entity type:Individual
Prefix:
First Name:KAITLYN
Middle Name:ANN
Last Name:WATKINS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9401 JERONIMO RD
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92618-1908
Mailing Address - Country:US
Mailing Address - Phone:760-525-2593
Mailing Address - Fax:
Practice Address - Street 1:9401 JERONIMO RD
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92618-1908
Practice Address - Country:US
Practice Address - Phone:760-525-2593
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-12
Last Update Date:2025-03-05
Deactivation Date:2025-02-11
Deactivation Code:
Reactivation Date:2025-02-20
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant