Provider Demographics
NPI:1174543664
Name:KITSON, NANCY ELLEN (MD)
Entity type:Individual
Prefix:DR
First Name:NANCY
Middle Name:ELLEN
Last Name:KITSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MISS
Other - First Name:NANCY
Other - Middle Name:ELLEN
Other - Last Name:WILSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1560 MESA RD STE 100
Mailing Address - Street 2:
Mailing Address - City:NIPOMO
Mailing Address - State:CA
Mailing Address - Zip Code:93444-6709
Mailing Address - Country:US
Mailing Address - Phone:805-614-5640
Mailing Address - Fax:805-614-5641
Practice Address - Street 1:1560 MESA RD STE 100
Practice Address - Street 2:
Practice Address - City:NIPOMO
Practice Address - State:CA
Practice Address - Zip Code:93444-6709
Practice Address - Country:US
Practice Address - Phone:805-614-5640
Practice Address - Fax:805-614-5641
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2023-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO37659207Q00000X
CAG162576207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMN5593Medicaid
AZ917841Medicaid
CO99587378Medicaid
8HD194Medicare PIN
CO49181Medicare ID - Type Unspecified
CO99587378Medicaid
320059Medicare Oscar/Certification
AZ917841Medicaid