Provider Demographics
NPI:1578337457
Name:MCKITTRICK, JAMIE (BSN, CRRN, NC-BC)
Entity Type:Individual
Prefix:
First Name:JAMIE
Middle Name:
Last Name:MCKITTRICK
Suffix:
Gender:F
Credentials:BSN, CRRN, NC-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 160
Mailing Address - Street 2:
Mailing Address - City:UNION
Mailing Address - State:KY
Mailing Address - Zip Code:41091-0160
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1157 FAIRMAN WAY UNIT 210
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:KY
Practice Address - Zip Code:41042-6504
Practice Address - Country:US
Practice Address - Phone:859-488-1615
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-10
Last Update Date:2023-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28220483-C163WR0400X, 163W00000X
174H00000X, 171400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171400000XOther Service ProvidersHealth & Wellness Coach
No163WR0400XNursing Service ProvidersRegistered NurseRehabilitationGroup - Single Specialty
No163W00000XNursing Service ProvidersRegistered NurseGroup - Single Specialty
No174H00000XOther Service ProvidersHealth Educator