Provider Demographics
NPI:1164559589
Name:CHITKO, KIMBERLEY DALTON (ARNP)
Entity Type:Individual
Prefix:MRS
First Name:KIMBERLEY
Middle Name:DALTON
Last Name:CHITKO
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1604 HOSPITAL PKWY STE 200
Mailing Address - Street 2:
Mailing Address - City:BEDFORD
Mailing Address - State:TX
Mailing Address - Zip Code:76022-6930
Mailing Address - Country:US
Mailing Address - Phone:817-848-4485
Mailing Address - Fax:817-848-4490
Practice Address - Street 1:1604 HOSPITAL PKWY STE 200
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:TX
Practice Address - Zip Code:76022
Practice Address - Country:US
Practice Address - Phone:817-848-4485
Practice Address - Fax:817-848-4490
Is Sole Proprietor?:No
Enumeration Date:2007-02-27
Last Update Date:2018-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9232299363L00000X
VA0024170572363LF0000X
MDR156907363LF0000X
TXAP117670363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX468949YKPWMedicare PIN