Provider Demographics
NPI:1902608326
Name:TATE, KAITLIN LEE
Entity type:Individual
Prefix:
First Name:KAITLIN
Middle Name:LEE
Last Name:TATE
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:102 FRONT NINE DR
Mailing Address - Street 2:
Mailing Address - City:ELIZABETHTOWN
Mailing Address - State:KY
Mailing Address - Zip Code:42701-9029
Mailing Address - Country:US
Mailing Address - Phone:270-577-9635
Mailing Address - Fax:
Practice Address - Street 1:125 REARDON BLVD
Practice Address - Street 2:
Practice Address - City:BARDSTOWN
Practice Address - State:KY
Practice Address - Zip Code:40004-2034
Practice Address - Country:US
Practice Address - Phone:877-498-0319
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-26
Last Update Date:2025-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician