MEDICARE: TERRY ROBERT KITSON M.A.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103T00000X	Psychologist	0914	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	914	OTHER	NC	PSYCHOLOGICAL ASSOCIATE
2	24744	OTHER		SCHOOL PSYCHOLOGIST

General Provider Information

NPI Number	:	1730221201
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TERRY ROBERT KITSON M.A.

Provider Business Mailing Address
First Line	:	100 AZALEA PL
Second Line	:
City	:	CHAPEL HILL
State	:	NC
Zip	:	27517-8303
Country	:	US
Telephone Number	:	919-933-4727
Fax Number	:

Provider Business Practice Location Address
First Line	:	100 AZALEA PL
Second Line	:
City	:	CHAPEL HILL
State	:	NC
Zip	:	27517-8303
Country	:	US
Telephone Number	:	919-933-4727
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/13/2007
Last Update Date	:	07/08/2007

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