Healthcare Provider Details

I. General information

NPI: 1497474456
Provider Name (Legal Business Name): COURTNEY KITCHEN NNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/24/2022
Last Update Date: 08/24/2022
Certification Date: 08/24/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 ROCKLAND RD
WILMINGTON DE
19803-3607
US

IV. Provider business mailing address

1709 PANAMA ST
PHILADELPHIA PA
19103-6708
US

V. Phone/Fax

Practice location:
  • Phone: 803-207-6643
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LN0005X
TaxonomyCritical Care Neonatal Nurse Practitioner
License NumberLM-0010186
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: