Provider Demographics
NPI:1710496872
Name:KITE, ROBERT LEWIS (FNP-BC)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:LEWIS
Last Name:KITE
Suffix:
Gender:M
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14821 DAYTON PIKE STE B
Mailing Address - Street 2:
Mailing Address - City:SALE CREEK
Mailing Address - State:TN
Mailing Address - Zip Code:37373-5752
Mailing Address - Country:US
Mailing Address - Phone:423-486-9455
Mailing Address - Fax:423-486-9458
Practice Address - Street 1:14821 DAYTON PIKE STE B
Practice Address - Street 2:
Practice Address - City:SALE CREEK
Practice Address - State:TN
Practice Address - Zip Code:37373
Practice Address - Country:US
Practice Address - Phone:423-486-9455
Practice Address - Fax:423-486-9458
Is Sole Proprietor?:No
Enumeration Date:2017-09-21
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN23251363LF0000X
GARN191875363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner