Provider Demographics
NPI:1922066927
Name:MCKITTRICK, ANN E (MD)
Entity Type:Individual
Prefix:
First Name:ANN
Middle Name:E
Last Name:MCKITTRICK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3620 FOREST BEACH DR NW
Mailing Address - Street 2:
Mailing Address - City:GIG HARBOR
Mailing Address - State:WA
Mailing Address - Zip Code:98335-5850
Mailing Address - Country:US
Mailing Address - Phone:310-922-7703
Mailing Address - Fax:
Practice Address - Street 1:3620 FOREST BEACH DR NW
Practice Address - Street 2:
Practice Address - City:GIG HARBOR
Practice Address - State:WA
Practice Address - Zip Code:98335-5850
Practice Address - Country:US
Practice Address - Phone:310-922-7703
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-02
Last Update Date:2021-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD60602923207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAMD60602823Medicaid
CA00A410070Medicaid
CAWA41007AMedicare PIN