Provider Demographics
NPI:1558005140
Name:WISE, KAITLYN JANAE MCCOLLUM (MD)
Entity type:Individual
Prefix:
First Name:KAITLYN
Middle Name:JANAE MCCOLLUM
Last Name:WISE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:KAITLYN
Other - Middle Name:JANAE
Other - Last Name:MCCOLLUM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3333 BURNET AVE # MLC9016
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45229-3026
Mailing Address - Country:US
Mailing Address - Phone:513-803-4829
Mailing Address - Fax:513-803-9244
Practice Address - Street 1:3333 BURNET AVE # MLC9016
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45229-3026
Practice Address - Country:US
Practice Address - Phone:513-803-4829
Practice Address - Fax:513-803-9244
Is Sole Proprietor?:No
Enumeration Date:2022-04-21
Last Update Date:2025-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program