Provider Demographics
NPI:1407450844
Name:KITCHEN, GERALD ROBERT
Entity Type:Individual
Prefix:MR
First Name:GERALD
Middle Name:ROBERT
Last Name:KITCHEN
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 1:1301 MEADOW BRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:BEAVERCREEK
Mailing Address - State:OH
Mailing Address - Zip Code:45432-2602
Mailing Address - Country:US
Mailing Address - Phone:937-266-5557
Mailing Address - Fax:
Practice Address - Street 1:548 CARTHAGE DR
Practice Address - Street 2:
Practice Address - City:BEAVERCREEK
Practice Address - State:OH
Practice Address - Zip Code:45434-5802
Practice Address - Country:US
Practice Address - Phone:937-684-7795
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-25
Last Update Date:2020-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374U00000XNursing Service Related ProvidersHome Health AideGroup - Single Specialty