MEDICARE: KAITLIN BEARD

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
1	247200000X	Other Technician

General Provider Information

NPI Number	:	1467994574
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAITLIN BEARD

Provider Business Mailing Address
First Line	:	5915 S RAINBOW BLVD
Second Line	:	SUITE 105
City	:	LAS VEGAS
State	:	NV
Zip	:	89118-2557
Country	:	US
Telephone Number	:	702-209-0370
Fax Number	:	702-405-0935

Provider Business Practice Location Address
First Line	:	5915 S RAINBOW BLVD
Second Line	:	SUITE 105
City	:	LAS VEGAS
State	:	NV
Zip	:	89118-2557
Country	:	US
Telephone Number	:	702-209-0370
Fax Number	:	702-405-0935

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/07/2016
Last Update Date	:	11/07/2016

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Directions to “ KAITLIN BEARD ” Practice Location

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