MEDICARE: KAITLYN UNDERWOOD BS, ATS

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	390200000X	Student in an Organized Health Care Education/Training Program		VA

General Provider Information

NPI Number	:	1821957457
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAITLYN UNDERWOOD BS, ATS

Provider Business Mailing Address
First Line	:	11301 SUNFIELD DR
Second Line	:
City	:	MIDLOTHIAN
State	:	VA
Zip	:	23112-3236
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	11301 SUNFIELD DR
Second Line	:
City	:	MIDLOTHIAN
State	:	VA
Zip	:	23112-3236
Country	:	US
Telephone Number	:	804-517-1127
Fax Number	:

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

Provider Enumeration Date	:	01/20/2026
Last Update Date	:	01/20/2026

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