Provider Demographics
NPI:1053088187
Name:BOLLINGER, KAITLYN
Entity type:Individual
Prefix:
First Name:KAITLYN
Middle Name:
Last Name:BOLLINGER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:436 DEPO STREET
Mailing Address - Street 2:
Mailing Address - City:BURNSVILLE
Mailing Address - State:WV
Mailing Address - Zip Code:26335
Mailing Address - Country:US
Mailing Address - Phone:304-644-4805
Mailing Address - Fax:
Practice Address - Street 1:436 DEPO STREET
Practice Address - Street 2:
Practice Address - City:BURNSVILLE
Practice Address - State:WV
Practice Address - Zip Code:26335
Practice Address - Country:US
Practice Address - Phone:304-644-4805
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-26
Last Update Date:2021-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant