Provider Demographics
NPI:1902799455
Name:PAULSON, KAITLYN JANE (MLS)
Entity type:Individual
Prefix:
First Name:KAITLYN
Middle Name:JANE
Last Name:PAULSON
Suffix:
Gender:F
Credentials:MLS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:509 GARDEN AVE NW
Mailing Address - Street 2:
Mailing Address - City:WEST FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58078-1109
Mailing Address - Country:US
Mailing Address - Phone:701-200-3673
Mailing Address - Fax:
Practice Address - Street 1:509 GARDEN AVE NW
Practice Address - Street 2:
Practice Address - City:WEST FARGO
Practice Address - State:ND
Practice Address - Zip Code:58078-1109
Practice Address - Country:US
Practice Address - Phone:701-200-3673
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-02
Last Update Date:2025-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND23-1063-I291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory