Healthcare Provider Details

I. General information

NPI: 1194452862
Provider Name (Legal Business Name): KAITLYN BARNETT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/03/2022
Last Update Date: 06/02/2023
Certification Date: 06/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

721 CHUCK GRAY CT
OWENSBORO KY
42303-7308
US

IV. Provider business mailing address

1321 MURFREESBORO PIKE STE 410
NASHVILLE TN
37217-2665
US

V. Phone/Fax

Practice location:
  • Phone: 270-843-5383
  • Fax:
Mailing address:
  • Phone: 615-696-6761
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number10827
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-23-274421
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: