Provider Demographics
NPI:1376143164
Name:KITENGE, JEAN-MARC
Entity Type:Individual
Prefix:
First Name:JEAN-MARC
Middle Name:
Last Name:KITENGE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6007 ALLENDALE RIDGE TRL
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:TX
Mailing Address - Zip Code:77407-1036
Mailing Address - Country:US
Mailing Address - Phone:254-213-8047
Mailing Address - Fax:
Practice Address - Street 1:6007 ALLENDALE RIDGE TRL
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:TX
Practice Address - Zip Code:77407-1036
Practice Address - Country:US
Practice Address - Phone:254-213-8047
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-29
Last Update Date:2021-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX883857251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health