Provider Demographics
NPI:1134476492
Name:KITTELL, JENNIFER
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:KITTELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1368
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12201-1368
Mailing Address - Country:US
Mailing Address - Phone:518-363-8815
Mailing Address - Fax:518-363-8831
Practice Address - Street 1:665 SARATOGA RD
Practice Address - Street 2:SUITE 100
Practice Address - City:GANSEVOORT
Practice Address - State:NY
Practice Address - Zip Code:12831-1599
Practice Address - Country:US
Practice Address - Phone:518-363-8815
Practice Address - Fax:518-363-8831
Is Sole Proprietor?:No
Enumeration Date:2012-08-06
Last Update Date:2017-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001495176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife