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 1:307 BOATNER RD STE 114
Mailing Address - Street 2:
Mailing Address - City:EGLIN AFB
Mailing Address - State:FL
Mailing Address - Zip Code:32542-1302
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:307 BOATNER RD STE 114
Practice Address - Street 2:
Practice Address - City:EGLIN AFB
Practice Address - State:FL
Practice Address - Zip Code:32542-1302
Practice Address - Country:US
Practice Address - Phone:163-852-8383
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-27
Last Update Date:2023-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171000000X
FLARNP 9348769176B00000X
FLCNM3438176B00000X
FLAPRN9348769367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No171000000XOther Service ProvidersMilitary Health Care Provider
No176B00000XOther Service ProvidersMidwife