Provider Demographics
NPI:1821866914
Name:BEAN, KAITLYN D (CPT,CCMA)
Entity Type:Individual
Prefix:
First Name:KAITLYN
Middle Name:D
Last Name:BEAN
Suffix:
Gender:F
Credentials:CPT,CCMA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4727 VALLEY VIEW BLVD NW # 1027
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24012-2000
Mailing Address - Country:US
Mailing Address - Phone:276-730-5065
Mailing Address - Fax:
Practice Address - Street 1:5120 PIN OAK DR
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24019-2512
Practice Address - Country:US
Practice Address - Phone:276-730-5065
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-18
Last Update Date:2024-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA64104246RP1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomyGroup - Multi-Specialty