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General NPI Number Information
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NPI Number | 1952778441
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Entity Type | Individual
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Provider Name | KAITLYN VICTORIA FREDRICK APN, PMHNP-BC
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Gender | Female
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Dates
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Enumeration Date | 08/31/2015
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Last Update Date | 06/11/2021
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Provider Practice Location Address
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Address Line | 1525 CLIFTON RD NE
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City | ATLANTA
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State | GA
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Zip | 30322-4200
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Country | US
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Telephone | 404-727-6145
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Fax |
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Provider Business Mailing Address
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Address Line | 274 JOSEPHINE ST NE
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City | ATLANTA
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State | GA
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Zip | 30307-2002
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Country | US
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Telephone | 901-496-3631
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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 | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 201509309NP-PP
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License Number State | OR
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Taxonomy #2
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | RN290699
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License Number State | GA
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