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NPI Code Detail

MEDICARE: KAITLYN WOOTON PA

MEDICARE: KAITLYN WOOTON PA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363A00000XPhysician Assistant
2363A00000XPhysician Assistant60147CA

General Provider Information

NPI Number : 1902570351
Entity Type Code : Individual
Provider Name (Legal Business Name) : KAITLYN WOOTON PA
Provider Business Mailing Address
First Line : 33562 YUCAIPA BLVD STE 4-219
Second Line :
City : YUCAIPA
State : CA
Zip : 92399-2072
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 11234 ANDERSON ST
Second Line :
City : LOMA LINDA
State : CA
Zip : 92350-1716
Country : US
Telephone Number : 909-558-4000
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/08/2021
Last Update Date : 01/26/2026

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Directions to “ KAITLYN WOOTON PA” Practice Location

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