Kaitlin Reiss Anderson, DNP, CPNP
Individual provider Active NPI Pediatric Nurse Practitioner · Atascadero, CA
NPI 1346645595 · NPPES record last updated Mar 18, 2021
Key facts
- NPI
- 1346645595
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pediatric Nurse Practitioner 363LP0200X
- License
- 95012201 (CA)
- Practice address
- 7700 Morro Rd
Atascadero, CA 93422-4435 - Phone
- (805) 466-6622
- Fax
- (805) 461-0361
- NPI assigned
- Oct 30, 2014
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Certified Pediatric Nurse Practitioner, Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 225342 | SC | MD | Registered Nurse |
| 21374 | SC | MD | Pediatric Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Es Pediatric Partners LLC | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Nurse | 163W00000X | 225342 | SC | |
| Pediatric Nurse Practitioner | 363LP0200X | 21374 | SC | |
| Pediatric Nurse Practitioner | 363LP0200X | 95012201 | CA | Yes |
Addresses
Primary practice location
7700 Morro Rd
Atascadero, CA 93422-4435
Mailing address
7700 Morro Rd
Atascadero, CA 93422-4435
Phone (805) 466-6622
Other practice location 1
2014 Bees Ferry Rd
Charleston, SC 29414-6603
Phone (843) 556-1070
Other practice location 2
435 Marina Dr
Georgetown, SC 29440-2410
Phone (843) 833-8595
Other names
- Kaitlin Elizabeth Reiss
Other providers in Atascadero, CA
- Ronalyn Macayan Amor
- Daniel Anderson
- David C Anderson II
- Hilary Abbott Anderson
- Jacquelin Savannah Anderson
- Jamie Andreozzi
- Ciara Andrews
- Madeline Angelotti
- Rebecca Aponte
- Ethan Sumner App
All providers in Atascadero, CA · Pediatric Nurse Practitioner in California
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 18, 2021. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.