Provider Demographics
NPI:1760178172
Name:GUTENSON, KAITLIN E (PA)
Entity type:Individual
Prefix:
First Name:KAITLIN
Middle Name:E
Last Name:GUTENSON
Suffix:
Gender:F
Credentials:PA
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Mailing Address - Street 1:81 SWEETWATER RD
Mailing Address - Street 2:
Mailing Address - City:LYNCHBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24501-7721
Mailing Address - Country:US
Mailing Address - Phone:703-268-3983
Mailing Address - Fax:
Practice Address - Street 1:1175 CORPORATE PARK DR
Practice Address - Street 2:
Practice Address - City:FOREST
Practice Address - State:VA
Practice Address - Zip Code:24551-2238
Practice Address - Country:US
Practice Address - Phone:434-525-6964
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-18
Last Update Date:2024-09-27
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant