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General NPI Number Information
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NPI Number | 1093584872
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Entity Type | Individual
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Provider Name | KAITLYN ANN MADDEN PHYSICIAN ASSISTANT
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Gender | Female
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Dates
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Enumeration Date | 12/21/2023
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Last Update Date | 06/02/2025
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Provider Practice Location Address
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Address Line | 5160 OCEAN HWY W
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City | SHALLOTTE
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State | NC
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Zip | 28470-4012
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Country | US
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Telephone | 910-332-3800
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 5105
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City | BELFAST
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State | ME
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Zip | 04915-5100
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Country | US
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Telephone | 610-636-0405
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 0010-15236
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License Number State | NC
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