Provider Demographics
NPI:1588213391
Name:EGAN, KAITLYN (CNM)
Entity type:Individual
Prefix:
First Name:KAITLYN
Middle Name:
Last Name:EGAN
Suffix:
Gender:
Credentials:CNM
Other - Prefix:
Other - First Name:KAITLYN
Other - Middle Name:
Other - Last Name:KERR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CNM
Mailing Address - Street 1:200 MILL RD
Mailing Address - Street 2:
Mailing Address - City:FAIRHAVEN
Mailing Address - State:MA
Mailing Address - Zip Code:02719-5252
Mailing Address - Country:US
Mailing Address - Phone:508-973-2000
Mailing Address - Fax:508-973-2001
Practice Address - Street 1:543 NORTH MAIN STREET
Practice Address - Street 2:
Practice Address - City:NEW BEDFORD
Practice Address - State:MA
Practice Address - Zip Code:02740
Practice Address - Country:US
Practice Address - Phone:508-973-2208
Practice Address - Fax:508-973-1225
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-05
Last Update Date:2025-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11004054367A00000X
MARN2350164367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL104226000Medicaid