Healthcare Provider Details

I. General information

NPI: 1528067154
Provider Name (Legal Business Name): WINSTON KITCHIN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 07/15/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date: 07/18/2005
Reactivation Date: 07/19/2005

III. Provider practice location address

4200 CLOVERLEAF DRIVE SUITE J-K
ST.PETERS MO
63376
US

IV. Provider business mailing address

13065 OLD TESSON FERRY RD
SAINT LOUIS MO
63128-3441
US

V. Phone/Fax

Practice location:
  • Phone: 636-928-5109
  • Fax: 636-447-4678
Mailing address:
  • Phone: 314-843-4333
  • Fax: 314-843-4856

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberR6H47
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: