Provider Demographics
NPI:1760881056
Name:NELSON, KAITLIN CHRISTINE (PA-C)
Entity type:Individual
Prefix:
First Name:KAITLIN
Middle Name:CHRISTINE
Last Name:NELSON
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:KAITLIN
Other - Middle Name:
Other - Last Name:INGHRAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:200 HAWKINS DR
Mailing Address - Street 2:
Mailing Address - City:IOWA CITY
Mailing Address - State:IA
Mailing Address - Zip Code:52242-1009
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:701 W FOREVERGREEN RD
Practice Address - Street 2:
Practice Address - City:NORTH LIBERTY
Practice Address - State:IA
Practice Address - Zip Code:52317-9848
Practice Address - Country:US
Practice Address - Phone:319-356-2223
Practice Address - Fax:319-353-6745
Is Sole Proprietor?:No
Enumeration Date:2014-08-22
Last Update Date:2025-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA133152363A00000X, 363AS0400X
IL085-005117363AS0400X
MN2571363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant