Provider Demographics
NPI:1679742258
Name:KITCHEN, CHRISTINA MORAN (FNP)
Entity Type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:MORAN
Last Name:KITCHEN
Suffix:
Gender:F
Credentials:FNP
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 3306
Mailing Address - Street 2:
Mailing Address - City:IDAHO FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83403-3306
Mailing Address - Country:US
Mailing Address - Phone:307-734-1201
Mailing Address - Fax:307-734-1165
Practice Address - Street 1:555 E BROADWAY AVE
Practice Address - Street 2:SUITE 108
Practice Address - City:JACKSON
Practice Address - State:WY
Practice Address - Zip Code:83001-8640
Practice Address - Country:US
Practice Address - Phone:307-734-1005
Practice Address - Fax:307-734-1165
Is Sole Proprietor?:No
Enumeration Date:2008-02-27
Last Update Date:2015-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY24423.0895363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily