Provider Demographics
NPI:1457760084
Name:KITCHELL, MEREDITH COWART (MMS, PA-C)
Entity Type:Individual
Prefix:MRS
First Name:MEREDITH
Middle Name:COWART
Last Name:KITCHELL
Suffix:
Gender:F
Credentials:MMS, PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1265 36TH STREET
Mailing Address - Street 2:
Mailing Address - City:VERO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32960
Mailing Address - Country:US
Mailing Address - Phone:772-567-6340
Mailing Address - Fax:772-567-3564
Practice Address - Street 1:1265 36TH STREET
Practice Address - Street 2:
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32960
Practice Address - Country:US
Practice Address - Phone:772-567-6340
Practice Address - Fax:772-567-3564
Is Sole Proprietor?:No
Enumeration Date:2014-08-07
Last Update Date:2019-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2144363A00000X
FLPA9111150363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant