Provider Demographics
NPI:1043320054
Name:MESSER, KITTIE (RN)
Entity Type:Individual
Prefix:
First Name:KITTIE
Middle Name:
Last Name:MESSER
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:625 GOVERNMENT ST
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:AL
Mailing Address - Zip Code:36274-1926
Mailing Address - Country:US
Mailing Address - Phone:256-794-0947
Mailing Address - Fax:334-863-3314
Practice Address - Street 1:625 GOVERNMENT ST
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:AL
Practice Address - Zip Code:36274-1926
Practice Address - Country:US
Practice Address - Phone:256-794-0947
Practice Address - Fax:334-863-3314
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2008-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-019041364SP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0809XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Adult
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51596Medicare ID - Type Unspecified