Provider Demographics
NPI:1922329903
Name:KITTELSON, AMANDA J (PA)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:J
Last Name:KITTELSON
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:
Other - Last Name:FRANK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:CARRIS HEALTH-REDWOOD
Mailing Address - Street 2:100 FALLWOOD ROAD
Mailing Address - City:REDWOOD FALLS
Mailing Address - State:MN
Mailing Address - Zip Code:56283
Mailing Address - Country:US
Mailing Address - Phone:507-637-4500
Mailing Address - Fax:507-532-2951
Practice Address - Street 1:CARRIS HEALTH-REDWOOD
Practice Address - Street 2:100 FALLWOOD ROAD
Practice Address - City:REDWOOD FALLS
Practice Address - State:MN
Practice Address - Zip Code:56283
Practice Address - Country:US
Practice Address - Phone:507-637-4500
Practice Address - Fax:507-532-2951
Is Sole Proprietor?:No
Enumeration Date:2010-06-14
Last Update Date:2022-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NDPAC0424363A00000X
MN11131363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND715199Medicare PIN