Provider Demographics
NPI:1073764775
Name:KITCHEN, JERI S (CNM)
Entity Type:Individual
Prefix:
First Name:JERI
Middle Name:S
Last Name:KITCHEN
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:90 JACKSON PIKE
Mailing Address - Street 2:
Mailing Address - City:GALLIPOLIS
Mailing Address - State:OH
Mailing Address - Zip Code:45631-1560
Mailing Address - Country:US
Mailing Address - Phone:740-446-5381
Mailing Address - Fax:740-446-5082
Practice Address - Street 1:100 JACKSON PIKE
Practice Address - Street 2:
Practice Address - City:GALLIPOLIS
Practice Address - State:OH
Practice Address - Zip Code:45631-1560
Practice Address - Country:US
Practice Address - Phone:740-446-5381
Practice Address - Fax:740-446-5082
Is Sole Proprietor?:No
Enumeration Date:2008-10-01
Last Update Date:2019-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV156367A00000X
OHAPRN.CNM.10281367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
P00725268OtherRAILROAD MEDICARE
KINM03651OtherMEDICARE
OH000000258858OtherOHIO MEDICAID UNISON
OH310917085200OtherOHIO MEDICAID CARESOURCE
OH2875376OtherOHIO MEDICAID MOLINA
OH2875376Medicaid
WV3810013407Medicaid