Provider Demographics
NPI:1114771698
Name:KITCHEN, MICHELLE ANTOINETTE (FNP)
Entity Type:Individual
Prefix:MS
First Name:MICHELLE
Middle Name:ANTOINETTE
Last Name:KITCHEN
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:339 ENTERPRISE AVE
Mailing Address - Street 2:
Mailing Address - City:MERLIN
Mailing Address - State:OR
Mailing Address - Zip Code:97532-9802
Mailing Address - Country:US
Mailing Address - Phone:817-994-4997
Mailing Address - Fax:
Practice Address - Street 1:214 NE OUTLOOK AVE
Practice Address - Street 2:
Practice Address - City:GRANTS PASS
Practice Address - State:OR
Practice Address - Zip Code:97526-1412
Practice Address - Country:US
Practice Address - Phone:541-474-5665
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-12
Last Update Date:2024-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR10024886363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily