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General NPI Number Information
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NPI Number | 1417455817
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Entity Type | Individual
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Provider Name | KAITLYN MARIE RAUWERDINK PHYSICIAN ASSISTANT
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Gender | Female
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Dates
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Enumeration Date | 01/31/2018
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Last Update Date | 03/17/2018
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Provider Practice Location Address
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Address Line | 2 SAINT VINCENT CIR FL 6
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City | LITTLE ROCK
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State | AR
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Zip | 72205-5423
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Country | US
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Telephone | 501-265-0619
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Fax |
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Provider Business Mailing Address
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Address Line | 6412 PAWNEE DR
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City | NORTH LITTLE ROCK
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State | AR
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Zip | 72116-5790
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Country | US
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Telephone | 920-980-4672
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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 |
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License Number State |
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