Provider Demographics
NPI:1730234345
Name:KITTELSON, BRIAN DENNIS (DNP, ARNP, FNP-C)
Entity type:Individual
Prefix:MR
First Name:BRIAN
Middle Name:DENNIS
Last Name:KITTELSON
Suffix:
Gender:M
Credentials:DNP, ARNP, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:875 S VANGUARD WAY
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83642-7552
Mailing Address - Country:US
Mailing Address - Phone:208-884-2922
Mailing Address - Fax:208-884-2923
Practice Address - Street 1:875 S VANGUARD WAY
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83642-7552
Practice Address - Country:US
Practice Address - Phone:208-884-2922
Practice Address - Fax:208-884-2923
Is Sole Proprietor?:No
Enumeration Date:2007-01-24
Last Update Date:2021-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDNP-958363LF0000X, 363LF0000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
IDNP-958OtherSTATE OF IDAHO BOARD OF NURSING
FLARNP 3080462OtherFLORIDA ARNP LICENSE
MSR877553OtherARNP LICENSE MS