1710439575 NPI number — DR. KAITLYN JESSICA BATHOLD DNP

Table of content: DR. KAITLYN JESSICA BATHOLD DNP (NPI 1710439575)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1710439575 NPI number — DR. KAITLYN JESSICA BATHOLD DNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BATHOLD
Provider First Name:
KAITLYN
Provider Middle Name:
JESSICA
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
WHITE
Provider Other First Name:
KAITLYN
Provider Other Middle Name:
JESSICA
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
DNP
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1710439575
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/13/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
673RD WOMENS HEALTH CLINIC
Provider Second Line Business Mailing Address:
5955 ZEAMER AVENUE
Provider Business Mailing Address City Name:
JOINT BASE ELMENDORF-RICHARDSON
Provider Business Mailing Address State Name:
AK
Provider Business Mailing Address Postal Code:
99506
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5955 ZEAMER AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
JBER
Provider Business Practice Location Address State Name:
AK
Provider Business Practice Location Address Postal Code:
99506-3702
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
907-580-5808
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/27/2016

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 171000000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 176B00000X , with the licence number: CNM3438 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 176B00000X , with the licence number: ARNP 9348769 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 367A00000X , with the licence number: APRN9348769 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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