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General NPI Number Information
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NPI Number | 1760777098
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Entity Type | Individual
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Provider Name | CONNIE P KITCHEN FNPC, RN & PA
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Gender | Female
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Dates
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Enumeration Date | 06/15/2011
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Last Update Date | 06/15/2011
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Provider Practice Location Address
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Address Line | 192 VILLAGE DR
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City | JACKSONVILLE
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State | NC
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Zip | 28546
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Country | US
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Telephone | 910-577-1400
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Fax | 910-577-2725
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Provider Business Mailing Address
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Address Line | 192 VILLAGE DR
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City | JACKSONVILLE
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State | NC
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Zip | 28546
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Country | US
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Telephone | 910-577-2770
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Fax | 910-577-2766
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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 | 363LA2100X
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Taxonomy Name | Acute Care Nurse Practitioner
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License Number | 200139
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License Number State | NC
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