Provider Demographics
NPI:1588362230
Name:JUSTICE, KAITLYN DEAN
Entity type:Individual
Prefix:
First Name:KAITLYN
Middle Name:DEAN
Last Name:JUSTICE
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 1:3369 E SHELBIANA RD
Mailing Address - Street 2:
Mailing Address - City:PIKEVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:41501-7705
Mailing Address - Country:US
Mailing Address - Phone:606-205-2574
Mailing Address - Fax:
Practice Address - Street 1:7160 N MAYO TRL
Practice Address - Street 2:
Practice Address - City:PIKEVILLE
Practice Address - State:KY
Practice Address - Zip Code:41501-3151
Practice Address - Country:US
Practice Address - Phone:606-657-9988
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-22
Last Update Date:2023-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator