Provider Demographics
NPI:1578234514
Name:KITCHENS, SUZAN DIANE (RN)
Entity Type:Individual
Prefix:
First Name:SUZAN
Middle Name:DIANE
Last Name:KITCHENS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2516 59TH ST
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79413-5638
Mailing Address - Country:US
Mailing Address - Phone:806-715-7290
Mailing Address - Fax:
Practice Address - Street 1:419 N JACKSON AVE
Practice Address - Street 2:
Practice Address - City:ODESSA
Practice Address - State:TX
Practice Address - Zip Code:79761-5124
Practice Address - Country:US
Practice Address - Phone:806-715-7290
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-21
Last Update Date:2021-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX807095163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health