Healthcare Provider Details

I. General information

NPI: 1326017161
Provider Name (Legal Business Name): JOHN ROBERT KITCHEN R.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 03/15/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

USA MEDDAC, EVANS ARMY COMMUNITY HOSPTIAL 1650 COCHRANE CIRCLE: ATTN: NUTRITION CARE DIVISION
FORT CARSON CO
80913-4604
US

IV. Provider business mailing address

USA MEDDAC, EVANS ARMY COMMUNITY HOSPITAL 1650 COCHRANE CIRCLE: ATTN CREDENTIALS OFFICE
FORT CARSON CO
80913-4604
US

V. Phone/Fax

Practice location:
  • Phone: 719-526-7968
  • Fax: 719-526-7586
Mailing address:
  • Phone: 719-526-7844
  • Fax: 719-526-7984

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133N00000X
TaxonomyNutritionist
License Number001459-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: