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General NPI Number Information
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NPI Number | 1558499780
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Entity Type | Individual
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Provider Name | MELISSA A. KITTO PA-C
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Gender | Female
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Dates
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Enumeration Date | 03/01/2007
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Last Update Date | 08/04/2015
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Provider Practice Location Address
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Address Line | 1800 SYRACUSE AVENUE PONCA HILLS HEALTH AND WELLNESS CENTER
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City | NOROFLK
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State | NE
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Zip | 68701
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Country | US
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Telephone | 402-371-8780
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Fax | 402-371-4094
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Provider Business Mailing Address
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Address Line | 53420 889 RD
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City | NIOBRARA
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State | NE
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Zip | 68760-7053
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Country | US
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Telephone | 605-760-5039
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Fax |
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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 | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 1315
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License Number State | NE
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