Healthcare Provider Details

I. General information

NPI: 1861313629
Provider Name (Legal Business Name): CHRISTINA KITCHEN PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/24/2026
Last Update Date: 07/24/2026
Certification Date: 07/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

250 SCOTT LN STE 105
JACKSON WY
83001-8060
US

IV. Provider business mailing address

250 SCOTT LN STE 105
JACKSON WY
83001-8060
US

V. Phone/Fax

Practice location:
  • Phone: 307-690-0782
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: CHRISTINA KITCHEN
Title or Position: FNP
Credential:
Phone: 307-690-0782