Healthcare Provider Details

I. General information

NPI: 1154059830
Provider Name (Legal Business Name): SUMMER ANN KIRTLEY NP, CNS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: SUMMER ANN MORGAN NP, CNS

II. Dates (important events)

Enumeration Date: 08/10/2022
Last Update Date: 08/10/2022
Certification Date: 08/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 W ARBOR DR # 8929
SAN DIEGO CA
92103-1911
US

IV. Provider business mailing address

1444 MAIN ST UNIT 1585
RAMONA CA
92065-8153
US

V. Phone/Fax

Practice location:
  • Phone: 909-319-3324
  • Fax:
Mailing address:
  • Phone: 909-319-3324
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0200X
TaxonomyPediatric Registered Nurse
License Number639490
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code364SP0200X
TaxonomyPediatric Clinical Nurse Specialist
License Number4447
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number21777
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: