Provider Demographics
NPI:1639867187
Name:KITCHEN, JACOB LEE (MS, RD, LD, LMNT)
Entity Type:Individual
Prefix:
First Name:JACOB
Middle Name:LEE
Last Name:KITCHEN
Suffix:
Gender:M
Credentials:MS, RD, LD, LMNT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1220 S 48TH ST
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68510-4814
Mailing Address - Country:US
Mailing Address - Phone:402-417-6302
Mailing Address - Fax:
Practice Address - Street 1:1220 S 48TH ST
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68510-4814
Practice Address - Country:US
Practice Address - Phone:402-417-6302
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-24
Last Update Date:2023-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE86326733133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered