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1760881056 NPI number — KAITLIN CHRISTINE NELSON PA-C

NPI Number: 1760881056
Health Care Provider/Practitioner: KAITLIN CHRISTINE NELSON PA-C

Information about “1760881056” NPI (KAITLIN CHRISTINE NELSON PA-C) exists in 1760881056 in HTML format HTML  |  1760881056 in plain Text format TXT  |  1760881056 in PDF (Portable Document Format) PDF  |  1760881056 in an XML format XML  formats.

NPI Number : 1760881056 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1760881056",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "NELSON",
    "FirstName": "KAITLIN",
    "MiddleName": "CHRISTINE",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "PA-C",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "INGHRAM",
    "OtherFirstName": "KAITLIN",
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": "1",
    "FirstLineMailingAddress": "200 HAWKINS DR",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "IOWA CITY",
    "MailingAddressStateName": "IA",
    "MailingAddressPostalCode": "52242-1009",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": null,
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "701 W FOREVERGREEN RD",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "NORTH LIBERTY",
    "PracticeLocationAddressStateName": "IA",
    "PracticeLocationAddressPostalCode": "52317-9848",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "319-356-2223",
    "PracticeLocationAddressFaxNumber": "319-353-6745",
    "EnumerationDate": "08/22/2014",
    "LastUpdateDate": "08/21/2025",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "F",
    "Gender": "Female",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "363A00000X",
          "TaxonomyName": "Physician Assistant",
          "LicenseNumber": "133152",
          "LicenseNumberStateCode": "IA",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "363AS0400X",
          "TaxonomyName": "Surgical Physician Assistant",
          "LicenseNumber": "085-005117",
          "LicenseNumberStateCode": "IL",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "363AS0400X",
          "TaxonomyName": "Surgical Physician Assistant",
          "LicenseNumber": "2571",
          "LicenseNumberStateCode": "MN",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "363AS0400X",
          "TaxonomyName": "Surgical Physician Assistant",
          "LicenseNumber": "133152",
          "LicenseNumberStateCode": "IA",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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