Provider Demographics
NPI:1861972671
Name:CRANNEY, KAITLYN (PA)
Entity type:Individual
Prefix:
First Name:KAITLYN
Middle Name:
Last Name:CRANNEY
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2502 25TH ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:IN
Mailing Address - Zip Code:47201-3728
Mailing Address - Country:US
Mailing Address - Phone:812-372-8883
Mailing Address - Fax:812-372-8964
Practice Address - Street 1:2502 25TH ST
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:IN
Practice Address - Zip Code:47201-3728
Practice Address - Country:US
Practice Address - Phone:812-372-8883
Practice Address - Fax:812-372-8964
Is Sole Proprietor?:No
Enumeration Date:2018-08-21
Last Update Date:2021-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN10002534A363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant