Provider Demographics
NPI:1356395727
Name:CHITTICK, JUDITH A (RNC, BES, MBA)
Entity type:Individual
Prefix:
First Name:JUDITH
Middle Name:A
Last Name:CHITTICK
Suffix:
Gender:F
Credentials:RNC, BES, MBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:502 FARRELL DR
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:41011-3717
Mailing Address - Country:US
Mailing Address - Phone:859-331-3292
Mailing Address - Fax:859-578-2864
Practice Address - Street 1:1201 S FORT THOMAS AVE
Practice Address - Street 2:
Practice Address - City:FORT THOMAS
Practice Address - State:KY
Practice Address - Zip Code:41075-2421
Practice Address - Country:US
Practice Address - Phone:859-781-3956
Practice Address - Fax:859-781-2171
Is Sole Proprietor?:No
Enumeration Date:2006-05-20
Last Update Date:2008-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1059599163WP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Adult