Healthcare Provider Details

I. General information

NPI: 1518572874
Provider Name (Legal Business Name): KAITLYN MARIEL OGDEN CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/14/2020
Last Update Date: 09/14/2020
Certification Date: 09/14/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1755 HIGHWAY 34 E
NEWNAN GA
30265-5631
US

IV. Provider business mailing address

PO BOX 73709
NEWNAN GA
30271-3709
US

V. Phone/Fax

Practice location:
  • Phone: 770-252-7510
  • Fax:
Mailing address:
  • Phone: 770-251-2060
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberRN239487
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: