Provider Demographics
NPI:1144850058
Name:KITCHENS, MARIN ELISE (PA-C)
Entity type:Individual
Prefix:
First Name:MARIN
Middle Name:ELISE
Last Name:KITCHENS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:MARIN
Other - Middle Name:
Other - Last Name:YOUNG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:247 S BURNETT RD STE 210
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:45505-2663
Mailing Address - Country:US
Mailing Address - Phone:937-328-8850
Mailing Address - Fax:937-328-8860
Practice Address - Street 1:247 S BURNETT RD STE 210
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:OH
Practice Address - Zip Code:45505-2663
Practice Address - Country:US
Practice Address - Phone:937-328-8850
Practice Address - Fax:937-328-8860
Is Sole Proprietor?:No
Enumeration Date:2020-01-20
Last Update Date:2022-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH50.006101RX363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant