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General NPI Number Information
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NPI Number | 1821866914
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Entity Type | Individual
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Provider Name | KAITLYN D BEAN CPT,CCMA
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Gender | Female
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Dates
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Enumeration Date | 12/18/2023
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Last Update Date | 01/09/2024
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Provider Practice Location Address
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Address Line | 5120 PIN OAK DR
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City | ROANOKE
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State | VA
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Zip | 24019-2512
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Country | US
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Telephone | 276-730-5065
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Fax |
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Provider Business Mailing Address
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Address Line | 4727 VALLEY VIEW BLVD NW # 1027
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City | ROANOKE
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State | VA
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Zip | 24012-2000
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Country | US
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Telephone | 276-730-5065
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 246RP1900X
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Taxonomy Name | Phlebotomy Technician
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License Number | 64104
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License Number State | VA
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