Provider Demographics
NPI:1548902547
Name:MCKITTRICK, KRISTI (SPECIALIST)
Entity type:Individual
Prefix:
First Name:KRISTI
Middle Name:
Last Name:MCKITTRICK
Suffix:
Gender:F
Credentials:SPECIALIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:114 WILSON DR
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:23188-2216
Mailing Address - Country:US
Mailing Address - Phone:757-561-5373
Mailing Address - Fax:
Practice Address - Street 1:114 WILSON DR
Practice Address - Street 2:
Practice Address - City:WILLIAMSBURG
Practice Address - State:VA
Practice Address - Zip Code:23188-2216
Practice Address - Country:US
Practice Address - Phone:757-561-5373
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-11
Last Update Date:2022-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA12011165141744P3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1744P3200XOther Service ProvidersSpecialistProsthetics Case Management