Provider Demographics
NPI:1710508478
Name:BADGER, KATELYNN ELIZABETH (CRNA)
Entity Type:Individual
Prefix:
First Name:KATELYNN
Middle Name:ELIZABETH
Last Name:BADGER
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 8
Mailing Address - Street 2:
Mailing Address - City:BAR HARBOR
Mailing Address - State:ME
Mailing Address - Zip Code:04609-0008
Mailing Address - Country:US
Mailing Address - Phone:207-288-5081
Mailing Address - Fax:207-288-8620
Practice Address - Street 1:10 WAYMAN LN
Practice Address - Street 2:
Practice Address - City:BAR HARBOR
Practice Address - State:ME
Practice Address - Zip Code:04609-1625
Practice Address - Country:US
Practice Address - Phone:207-288-5081
Practice Address - Fax:207-288-8620
Is Sole Proprietor?:No
Enumeration Date:2020-05-04
Last Update Date:2023-05-03
Deactivation Date:2023-01-04
Deactivation Code:
Reactivation Date:2023-01-12
Provider Licenses
StateLicense IDTaxonomies
OR202105376CRNA-P367500000X
CT126284367500000X
NH083873-23367500000X
MERNA223085367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered