Provider Demographics
NPI:1558954156
Name:BEYRAU, KAITLIN
Entity Type:Individual
Prefix:MS
First Name:KAITLIN
Middle Name:
Last Name:BEYRAU
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3551 ROGER BROOKE DRIVE
Mailing Address - Street 2:SAUSHEC ANESTHESIA RESIDENCY
Mailing Address - City:JBSA- FT SAM HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:78234-4504
Mailing Address - Country:US
Mailing Address - Phone:210-916-8666
Mailing Address - Fax:210-916-8712
Practice Address - Street 1:3551 ROGER BROOKE DRIVE
Practice Address - Street 2:SAUSHEC ANESTHESIA RESIDENCY
Practice Address - City:JBSA- FT SAM HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:78234-4504
Practice Address - Country:US
Practice Address - Phone:210-916-8666
Practice Address - Fax:210-916-8712
Is Sole Proprietor?:No
Enumeration Date:2021-02-15
Last Update Date:2022-09-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0101276249208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice