Healthcare Provider Details

I. General information

NPI: 1861920654
Provider Name (Legal Business Name): KAITLYN MARTIN DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/24/2017
Last Update Date: 01/29/2025
Certification Date: 01/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

155 HOSPITAL RD STE C
WINCHESTER TN
37398-2495
US

IV. Provider business mailing address

161 SHIRLEY DR
WINCHESTER TN
37398-2256
US

V. Phone/Fax

Practice location:
  • Phone: 931-962-3297
  • Fax: 931-967-0175
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number5101023050
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code207VX0000X
TaxonomyObstetrics Physician
License Number5151011767
License Number StateMI
# 3
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number4430
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: