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General NPI Number Information
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NPI Number | 1508772369
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Entity Type | Individual
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Provider Name | KAITLYN VICTORIA MUDGE DNP, APRN
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Gender | Female
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Dates
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Enumeration Date | 08/21/2026
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Last Update Date | 08/21/2026
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Provider Practice Location Address
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Address Line | 910 HALE PL STE 110
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City | CHULA VISTA
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State | CA
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Zip | 91914-3598
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Country | US
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Telephone | 619-704-7577
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Fax |
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Provider Business Mailing Address
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Address Line | 536 VIA DE LA VALLE UNIT A
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City | SOLANA BEACH
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State | CA
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Zip | 92075-2484
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Country | US
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Telephone | 619-704-7577
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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 | 363LP0200X
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Taxonomy Name | Pediatric Nurse Practitioner
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License Number | 95040593
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 95040593
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License Number State | CA
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