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NPI Code Detail

MEDICARE: KAITLYN DOUGLAS

MEDICARE: KAITLYN DOUGLAS
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1390200000XStudent in an Organized Health Care Education/Training Program732545PA

General Provider Information

NPI Number : 1033074521
Entity Type Code : Individual
Provider Name (Legal Business Name) : KAITLYN DOUGLAS
Provider Business Mailing Address
First Line : 364 PIN OAK DR
Second Line :
City : LITITZ
State : PA
Zip : 17543-3061
Country : US
Telephone Number : 717-598-5144
Fax Number :
Provider Business Practice Location Address
First Line : 169 MARTIN AVE
Second Line :
City : EPHRATA
State : PA
Zip : 17522-1734
Country : US
Telephone Number : 717-733-0311
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/17/2025
Last Update Date : 12/17/2025

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Directions to “ KAITLYN DOUGLAS ” Practice Location

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