Provider Demographics
NPI:1538440623
Name:MCKITTRICK, KELLY SUZANNE (CNM, ARNP)
Entity type:Individual
Prefix:MS
First Name:KELLY
Middle Name:SUZANNE
Last Name:MCKITTRICK
Suffix:
Gender:F
Credentials:CNM, ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:902 7TH ST STE 101
Mailing Address - Street 2:
Mailing Address - City:ANACORTES
Mailing Address - State:WA
Mailing Address - Zip Code:98221-4104
Mailing Address - Country:US
Mailing Address - Phone:360-298-8044
Mailing Address - Fax:216-930-5958
Practice Address - Street 1:902 7TH ST STE 101
Practice Address - Street 2:
Practice Address - City:ANACORTES
Practice Address - State:WA
Practice Address - Zip Code:98221-4104
Practice Address - Country:US
Practice Address - Phone:360-298-8044
Practice Address - Fax:216-930-5958
Is Sole Proprietor?:No
Enumeration Date:2011-09-01
Last Update Date:2025-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP60431476363LW0102X
WA60431476363LX0001X
IDCNM-60A367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
No363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology