Provider Demographics
NPI:1831579655
Name:BETHUNE, KAITLYN (FNP-BC)
Entity type:Individual
Prefix:
First Name:KAITLYN
Middle Name:
Last Name:BETHUNE
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:KAITLYN
Other - Middle Name:
Other - Last Name:JUSKIEWICZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP-BC
Mailing Address - Street 1:3803 FAIRFAX DR
Mailing Address - Street 2:SUITE 400
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22203-5860
Mailing Address - Country:US
Mailing Address - Phone:703-708-4380
Mailing Address - Fax:
Practice Address - Street 1:3803 FAIRFAX DR
Practice Address - Street 2:SUITE 400
Practice Address - City:ARLINGTON
Practice Address - State:VA
Practice Address - Zip Code:22203-5860
Practice Address - Country:US
Practice Address - Phone:703-708-4380
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-06
Last Update Date:2016-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024172624363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily