Provider Demographics
NPI:1023703550
Name:FLANAGAN, KAITLYN M
Entity type:Individual
Prefix:
First Name:KAITLYN
Middle Name:M
Last Name:FLANAGAN
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 1:3762 KINGSVILLE RD
Mailing Address - Street 2:
Mailing Address - City:COALTON
Mailing Address - State:WV
Mailing Address - Zip Code:26257-5709
Mailing Address - Country:US
Mailing Address - Phone:304-704-3660
Mailing Address - Fax:
Practice Address - Street 1:1408 HARRISON AVE
Practice Address - Street 2:
Practice Address - City:ELKINS
Practice Address - State:WV
Practice Address - Zip Code:26241-3325
Practice Address - Country:US
Practice Address - Phone:304-636-4390
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-10
Last Update Date:2023-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant