Provider Demographics
NPI:1518107275
Name:KITCH, JEFFREY R (APRN)
Entity Type:Individual
Prefix:MR
First Name:JEFFREY
Middle Name:R
Last Name:KITCH
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:230 KISSENA PARK CT
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:LA
Mailing Address - Zip Code:70435-0280
Mailing Address - Country:US
Mailing Address - Phone:985-875-9613
Mailing Address - Fax:
Practice Address - Street 1:1203 S TYLER ST
Practice Address - Street 2:STE E
Practice Address - City:COVINGTON
Practice Address - State:LA
Practice Address - Zip Code:70433-2353
Practice Address - Country:US
Practice Address - Phone:985-871-6020
Practice Address - Fax:985-871-6027
Is Sole Proprietor?:No
Enumeration Date:2009-02-20
Last Update Date:2011-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP03440363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily