Healthcare Provider Details

I. General information

NPI: 1972377943
Provider Name (Legal Business Name): KAITLYN BEROGAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/10/2023
Last Update Date: 02/20/2025
Certification Date: 02/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10608 FLICKENGER LN
KNOXVILLE TN
37922-3485
US

IV. Provider business mailing address

1628 EL PRADO DR
KNOXVILLE TN
37922-5718
US

V. Phone/Fax

Practice location:
  • Phone: 833-633-1576
  • Fax: 866-308-4392
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number34791
License Number StateTN
# 3
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number34791
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: