Healthcare Provider Details

I. General information

NPI: 1568143576
Provider Name (Legal Business Name): KAITLYN ELIZABETH ANDERSON AGNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/31/2023
Last Update Date: 07/31/2025
Certification Date: 07/31/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1414 PHYSICIANS DR
WILMINGTON NC
28401-7335
US

IV. Provider business mailing address

9488 NIGHT HARBOR DR
LELAND NC
28451-9594
US

V. Phone/Fax

Practice location:
  • Phone: 800-733-1476
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number5018564
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: