Healthcare Provider Details

I. General information

NPI: 1710439575
Provider Name (Legal Business Name): KAITLYN JESSICA BATHOLD DNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KAITLYN JESSICA WHITE DNP

II. Dates (important events)

Enumeration Date: 10/27/2016
Last Update Date: 08/13/2024
Certification Date: 08/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5955 ZEAMER AVE
JBER AK
99506-3702
US

IV. Provider business mailing address

673RD WOMENS HEALTH CLINIC 5955 ZEAMER AVENUE
JOINT BASE ELMENDORF-RICHARDSON AK
99506
US

V. Phone/Fax

Practice location:
  • Phone: 907-580-5808
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License NumberAPRN9348769
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code176B00000X
TaxonomyMidwife
License NumberCNM3438
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code176B00000X
TaxonomyMidwife
License NumberARNP 9348769
License Number StateFL
# 4
Primary TaxonomyN
Taxonomy Code171000000X
TaxonomyMilitary Health Care Provider
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: