Provider Demographics
NPI:1144365909
Name:KITCHEN, JERE' S (FNP)
Entity type:Individual
Prefix:MRS
First Name:JERE'
Middle Name:S
Last Name:KITCHEN
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1529 HUGUENOT RD STE A
Mailing Address - Street 2:
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:VA
Mailing Address - Zip Code:23113-2426
Mailing Address - Country:US
Mailing Address - Phone:804-378-7373
Mailing Address - Fax:804-378-7728
Practice Address - Street 1:1807 HUGUENOT RD
Practice Address - Street 2:SUITE 101
Practice Address - City:MIDLOTHIAN
Practice Address - State:VA
Practice Address - Zip Code:23113-5604
Practice Address - Country:US
Practice Address - Phone:804-378-7373
Practice Address - Fax:804-378-7728
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-20
Last Update Date:2016-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024165223363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAF25706Medicare UPIN