Healthcare Provider Details

I. General information

NPI: 1578337457
Provider Name (Legal Business Name): JAMIE MCKITTRICK BSN,CPHQ,CRRN,NC-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/10/2023
Last Update Date: 04/07/2025
Certification Date: 04/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10824 DORAL CT
UNION KY
41091-9226
US

IV. Provider business mailing address

PO BOX 160
UNION KY
41091-0160
US

V. Phone/Fax

Practice location:
  • Phone: 337-443-2584
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License Number28220483-C
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License Number28220483-C
License Number StateIN
# 3
Primary TaxonomyN
Taxonomy Code163WC1600X
TaxonomyContinuing Education/Staff Development Registered Nurse
License Number28220483-C
License Number StateIN
# 4
Primary TaxonomyN
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number28220483-C
License Number StateIN
# 5
Primary TaxonomyN
Taxonomy Code163WR0400X
TaxonomyRehabilitation Registered Nurse
License Number28220483-C
License Number StateIN
# 6
Primary TaxonomyN
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number State
# 7
Primary TaxonomyN
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number
License Number State
# 8
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number28220483-C
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: