Provider Demographics
NPI:1710642558
Name:KITTLE, JODY GLENN (MSN, APRN, PMHNP-BC)
Entity Type:Individual
Prefix:MR
First Name:JODY
Middle Name:GLENN
Last Name:KITTLE
Suffix:
Gender:M
Credentials:MSN, APRN, PMHNP-BC
Other - Prefix:MR
Other - First Name:JODY
Other - Middle Name:GLENN
Other - Last Name:KITTLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSN, APRN, PMHNP-BC
Mailing Address - Street 1:2201 OAKLEAF CT
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:TN
Mailing Address - Zip Code:37064-7409
Mailing Address - Country:US
Mailing Address - Phone:615-974-3103
Mailing Address - Fax:
Practice Address - Street 1:1909 MALLORY LN STE 200
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:TN
Practice Address - Zip Code:37067-2842
Practice Address - Country:US
Practice Address - Phone:615-771-1100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-06
Last Update Date:2024-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN32758363LP0808X
TN239979163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse