Healthcare Provider Details

I. General information

NPI: 1407631229
Provider Name (Legal Business Name): KAITLIN PRICE PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/29/2023
Last Update Date: 09/25/2026
Certification Date: 09/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10870 US ONE N UNIT 104
PONTE VEDRA BEACH FL
32081-7804
US

IV. Provider business mailing address

10870 US ONE N UNIT 104
PONTE VEDRA BEACH FL
32081-7804
US

V. Phone/Fax

Practice location:
  • Phone: 904-438-2720
  • Fax:
Mailing address:
  • Phone: 904-438-2720
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA9121889
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: