Provider Demographics
NPI:1023653995
Name:POND, KAITLIN (PA)
Entity type:Individual
Prefix:
First Name:KAITLIN
Middle Name:
Last Name:POND
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:KAITLIN
Other - Middle Name:
Other - Last Name:VAN WINKLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:PO BOX 419402
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02241-9402
Mailing Address - Country:US
Mailing Address - Phone:855-290-1552
Mailing Address - Fax:336-774-6872
Practice Address - Street 1:2632 SALEM CHURCH RD
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22407-6484
Practice Address - Country:US
Practice Address - Phone:540-899-3440
Practice Address - Fax:540-899-3434
Is Sole Proprietor?:No
Enumeration Date:2019-11-14
Last Update Date:2022-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0110006972363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant