Healthcare Provider Details

I. General information

NPI: 1790063204
Provider Name (Legal Business Name): HANNAH E KITTS FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/01/2011
Last Update Date: 06/13/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

731 E MAIN ST
JACKSON OH
45640-2100
US

IV. Provider business mailing address

731 E. MAIN STREET SUITE 4
JACKSON OH
45640
US

V. Phone/Fax

Practice location:
  • Phone: 740-577-3527
  • Fax: 740-577-3009
Mailing address:
  • Phone: 740-577-3527
  • Fax: 740-577-3009

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberCOA. 12470-NP
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: