Provider Demographics
NPI:1407237522
Name:KITCHEN, NICOLE ANN (PA)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:ANN
Last Name:KITCHEN
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:NICOLE
Other - Middle Name:ANN
Other - Last Name:AMEZQUITA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8010 FROST ST FL 2
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92123-4284
Mailing Address - Country:US
Mailing Address - Phone:589-398-3508
Mailing Address - Fax:
Practice Address - Street 1:8010 FROST ST FL 2
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92123-4284
Practice Address - Country:US
Practice Address - Phone:858-939-8350
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-15
Last Update Date:2020-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GUPA-109363A00000X
CA57023363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant