Provider Demographics
NPI:1710439575
Name:BATHOLD, KAITLYN JESSICA (DNP)
Entity type:Individual
Prefix:DR
First Name:KAITLYN
Middle Name:JESSICA
Last Name:BATHOLD
Suffix:
Gender:F
Credentials:DNP
Other - Prefix:
Other - First Name:KAITLYN
Other - Middle Name:JESSICA
Other - Last Name:WHITE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DNP
Mailing Address - Street 1:673RD WOMENS HEALTH CLINIC
Mailing Address - Street 2:5955 ZEAMER AVENUE
Mailing Address - City:JOINT BASE ELMENDORF-RICHARDSON
Mailing Address - State:AK
Mailing Address - Zip Code:99506
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5955 ZEAMER AVE
Practice Address - Street 2:
Practice Address - City:JBER
Practice Address - State:AK
Practice Address - Zip Code:99506-3702
Practice Address - Country:US
Practice Address - Phone:907-580-5808
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-27
Last Update Date:2024-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171000000X
FLCNM3438176B00000X
FLARNP 9348769176B00000X
FLAPRN9348769367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No171000000XOther Service ProvidersMilitary Health Care Provider
No176B00000XOther Service ProvidersMidwife