Provider Demographics
NPI:1467734434
Name:KITCHEN, DAVID J (CRNP)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:J
Last Name:KITCHEN
Suffix:
Gender:M
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 WHITE SPRUCE CT
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21234-1514
Mailing Address - Country:US
Mailing Address - Phone:410-882-0314
Mailing Address - Fax:
Practice Address - Street 1:501 S UNION AVE
Practice Address - Street 2:WOUND CARE CLINIC
Practice Address - City:HAVRE DE GRACE
Practice Address - State:MD
Practice Address - Zip Code:21078-3409
Practice Address - Country:US
Practice Address - Phone:443-843-6600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-15
Last Update Date:2011-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR140728363LA2200X, 363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology