Provider Demographics
NPI:1902203045
Name:KITTOCK, ALLYSSA MAE (PA)
Entity Type:Individual
Prefix:MRS
First Name:ALLYSSA
Middle Name:MAE
Last Name:KITTOCK
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Gender:F
Credentials:PA
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Mailing Address - Street 1:8170 33RD AVE S # MS 21110Q
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:MN
Mailing Address - Zip Code:55425-4516
Mailing Address - Country:US
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Practice Address - Street 1:5400 EXCELSIOR BLVD
Practice Address - Street 2:
Practice Address - City:ST LOUIS PARK
Practice Address - State:MN
Practice Address - Zip Code:55416-2913
Practice Address - Country:US
Practice Address - Phone:952-993-1000
Practice Address - Fax:952-993-1160
Is Sole Proprietor?:No
Enumeration Date:2014-12-03
Last Update Date:2022-06-29
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant