Provider Demographics
NPI:1396215141
Name:KITCHEN, ALISSA LAUREN
Entity Type:Individual
Prefix:
First Name:ALISSA
Middle Name:LAUREN
Last Name:KITCHEN
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 1:10965 CLARENDON ST
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33913-8562
Mailing Address - Country:US
Mailing Address - Phone:573-673-2754
Mailing Address - Fax:
Practice Address - Street 1:2010 59TH ST W STE 4200
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34209-4687
Practice Address - Country:US
Practice Address - Phone:941-794-3999
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-04
Last Update Date:2018-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant