Provider Demographics
NPI:1558499780
Name:KITTO, MELISSA A (PA-C)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:A
Last Name:KITTO
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:53420 889 RD
Mailing Address - Street 2:
Mailing Address - City:NIOBRARA
Mailing Address - State:NE
Mailing Address - Zip Code:68760-7053
Mailing Address - Country:US
Mailing Address - Phone:605-760-5039
Mailing Address - Fax:
Practice Address - Street 1:1800 SYRACUSE AVENUE
Practice Address - Street 2:PONCA HILLS HEALTH AND WELLNESS CENTER
Practice Address - City:NOROFLK
Practice Address - State:NE
Practice Address - Zip Code:68701
Practice Address - Country:US
Practice Address - Phone:402-371-8780
Practice Address - Fax:402-371-4094
Is Sole Proprietor?:No
Enumeration Date:2007-03-01
Last Update Date:2015-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1315363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical