Provider Demographics
NPI:1689936528
Name:HARBIN, KAITLIN (CRNA)
Entity type:Individual
Prefix:
First Name:KAITLIN
Middle Name:
Last Name:HARBIN
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:KAITLIN
Other - Middle Name:
Other - Last Name:GALLAGHER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNA
Mailing Address - Street 1:6701 N CHARLES ST
Mailing Address - Street 2:# 4226
Mailing Address - City:TOWSON
Mailing Address - State:MD
Mailing Address - Zip Code:21204-6808
Mailing Address - Country:US
Mailing Address - Phone:919-882-0705
Mailing Address - Fax:919-873-9821
Practice Address - Street 1:4045 RIVERSIDE PARKWAY
Practice Address - Street 2:
Practice Address - City:LEESBURG
Practice Address - State:VA
Practice Address - Zip Code:20176-5101
Practice Address - Country:US
Practice Address - Phone:703-858-6000
Practice Address - Fax:410-337-5068
Is Sole Proprietor?:No
Enumeration Date:2012-06-15
Last Update Date:2019-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR200684367500000X
VA0024172509367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1689936528Medicaid
MD487202900Medicaid
MD243138ZCXJMedicare PIN
VAVVI323AMedicare PIN
VA1689936528Medicaid