Provider Demographics
NPI:1508963299
Name:KITSON, JACQUELIN RANDY (RN, NP, BC)
Entity Type:Individual
Prefix:
First Name:JACQUELIN
Middle Name:RANDY
Last Name:KITSON
Suffix:
Gender:F
Credentials:RN, NP, BC
Other - Prefix:
Other - First Name:JACQUELIN
Other - Middle Name:RANDY
Other - Last Name:DICHTER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RN, NP, BC
Mailing Address - Street 1:174 WALTER HAYS DR
Mailing Address - Street 2:
Mailing Address - City:PALO ALTO
Mailing Address - State:CA
Mailing Address - Zip Code:94303-2923
Mailing Address - Country:US
Mailing Address - Phone:408-410-1608
Mailing Address - Fax:
Practice Address - Street 1:270 INTERNATIONAL CIR
Practice Address - Street 2:2 NORTH
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95119-1130
Practice Address - Country:US
Practice Address - Phone:408-363-4968
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-17
Last Update Date:2022-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA546807363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAP72091Medicare UPIN