MEDICARE: KAITLYN BEROGAN

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	101YP2500X	Professional Counselor
2	363LG0600X	Gerontology Nurse Practitioner	34791	TN
3	363LA2100X	Acute Care Nurse Practitioner	34791	TN

General Provider Information

NPI Number	:	1972377943
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAITLYN BEROGAN

Provider Business Mailing Address
First Line	:	1628 EL PRADO DR
Second Line	:
City	:	KNOXVILLE
State	:	TN
Zip	:	37922-5718
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	10608 FLICKENGER LN
Second Line	:
City	:	KNOXVILLE
State	:	TN
Zip	:	37922-3485
Country	:	US
Telephone Number	:	833-633-1576
Fax Number	:	866-308-4392

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

Provider Enumeration Date	:	11/10/2023
Last Update Date	:	02/20/2025

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Directions to “ KAITLYN BEROGAN ” Practice Location

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