Provider Demographics
NPI:1790429611
Name:HARVEY, KAITLAN SIERRA (MD)
Entity Type:Individual
Prefix:DR
First Name:KAITLAN
Middle Name:SIERRA
Last Name:HARVEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:KAITLAN
Other - Middle Name:SIERRA
Other - Last Name:CONN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:1367 PARK ST
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:WV
Mailing Address - Zip Code:25701-4023
Mailing Address - Country:US
Mailing Address - Phone:304-942-8677
Mailing Address - Fax:
Practice Address - Street 1:1340 HAL GREER BLVD
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:WV
Practice Address - Zip Code:25701-3804
Practice Address - Country:US
Practice Address - Phone:304-526-2000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-26
Last Update Date:2022-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program