Provider Demographics
NPI:1417598905
Name:KITKOWSKI, JENNIFER JOHNSON (APRN)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:JOHNSON
Last Name:KITKOWSKI
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:865 JUNCTION DR
Mailing Address - Street 2:
Mailing Address - City:ALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:75013-5006
Mailing Address - Country:US
Mailing Address - Phone:214-547-8300
Mailing Address - Fax:214-547-9787
Practice Address - Street 1:865 JUNCTION DR
Practice Address - Street 2:
Practice Address - City:ALLEN
Practice Address - State:TX
Practice Address - Zip Code:75013-5006
Practice Address - Country:US
Practice Address - Phone:214-547-8300
Practice Address - Fax:214-547-9787
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-04
Last Update Date:2021-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1038661363LF0000X
TN26614363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily