Provider Demographics
NPI:1891304168
Name:KITTLE, DEBORAH M (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:M
Last Name:KITTLE
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:DEBORAH
Other - Middle Name:M
Other - Last Name:PALMER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:325 S CEDAR AVE STE 2
Mailing Address - Street 2:
Mailing Address - City:SOUTH PITTSBURG
Mailing Address - State:TN
Mailing Address - Zip Code:37380-1322
Mailing Address - Country:US
Mailing Address - Phone:423-837-5801
Mailing Address - Fax:423-837-5807
Practice Address - Street 1:325 S CEDAR AVE STE 2
Practice Address - Street 2:
Practice Address - City:SOUTH PITTSBURG
Practice Address - State:TN
Practice Address - Zip Code:37380-1322
Practice Address - Country:US
Practice Address - Phone:423-837-5801
Practice Address - Fax:423-837-5807
Is Sole Proprietor?:No
Enumeration Date:2020-07-23
Last Update Date:2021-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN27676363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily