Healthcare Provider Details

I. General information

NPI: 1093642530
Provider Name (Legal Business Name): DEANNA REAGAN KITTRELL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/07/2026
Last Update Date: 05/07/2026
Certification Date: 05/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1416 E MAIN ST
COLDWATER KS
67029-7246
US

IV. Provider business mailing address

1416 E MAIN ST
COLDWATER KS
67029-7246
US

V. Phone/Fax

Practice location:
  • Phone: 620-582-5270
  • Fax:
Mailing address:
  • Phone: 620-582-5270
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number276880
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: