Provider Demographics
NPI:1922694801
Name:BERRIAN, KAITLYN MORGAN (PA-C)
Entity Type:Individual
Prefix:
First Name:KAITLYN
Middle Name:MORGAN
Last Name:BERRIAN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:240 E 85TH ST APT 4A
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10028-3048
Mailing Address - Country:US
Mailing Address - Phone:845-707-1482
Mailing Address - Fax:
Practice Address - Street 1:240 E 85TH ST APT 4A
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10028-3048
Practice Address - Country:US
Practice Address - Phone:845-707-1482
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-15
Last Update Date:2021-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY026256363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant