Provider Demographics
NPI:1952040511
Name:PHARR, KAITLIN BRIANNA
Entity Type:Individual
Prefix:
First Name:KAITLIN
Middle Name:BRIANNA
Last Name:PHARR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11053 HOOPER RD
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70818-3216
Mailing Address - Country:US
Mailing Address - Phone:225-603-2759
Mailing Address - Fax:
Practice Address - Street 1:12628 HOOPER RD
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70818-3500
Practice Address - Country:US
Practice Address - Phone:225-953-8170
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-01
Last Update Date:2022-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Single Specialty