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General NPI Number Information
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NPI Number | 1417415027
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Entity Type | Individual
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Provider Name | JENNIFER LYNNE KITTLER RN, FNP
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Gender | Female
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Dates
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Enumeration Date | 03/04/2019
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Last Update Date | 11/08/2024
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Provider Practice Location Address
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Address Line | 128 HIGHLAND PKWY STE 200
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City | PICAYUNE
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State | MS
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Zip | 39466-5578
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Country | US
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Telephone | 601-358-9630
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Fax | 601-358-9640
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Provider Business Mailing Address
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Address Line | 415 S 28TH AVE
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City | HATTIESBURG
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State | MS
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Zip | 39401-7246
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Country | US
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Telephone | 601-358-9630
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Fax | 601-579-5240
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 903118
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License Number State | MS
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Taxonomy #2
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 903118
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License Number State | MS
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