Provider Demographics
NPI:1386399376
Name:KNUTSEN, KAITLYN H
Entity type:Individual
Prefix:
First Name:KAITLYN
Middle Name:H
Last Name:KNUTSEN
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 1:710 E BOYD DR APT 308
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70808-6101
Mailing Address - Country:US
Mailing Address - Phone:225-252-8548
Mailing Address - Fax:
Practice Address - Street 1:9410 LINDALE AVE STE B
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70815-4160
Practice Address - Country:US
Practice Address - Phone:225-768-7246
Practice Address - Fax:800-768-7675
Is Sole Proprietor?:No
Enumeration Date:2022-02-17
Last Update Date:2022-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator