Provider Demographics
NPI:1811973266
Name:KITSMILLER, MARION JO (PA)
Entity type:Individual
Prefix:
First Name:MARION
Middle Name:JO
Last Name:KITSMILLER
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2010 NINE RD
Mailing Address - Street 2:
Mailing Address - City:BRADY
Mailing Address - State:TX
Mailing Address - Zip Code:76825-7210
Mailing Address - Country:US
Mailing Address - Phone:325-597-2114
Mailing Address - Fax:325-597-2155
Practice Address - Street 1:2010 NINE RD
Practice Address - Street 2:
Practice Address - City:BRADY
Practice Address - State:TX
Practice Address - Zip Code:76825-7210
Practice Address - Country:US
Practice Address - Phone:325-597-2114
Practice Address - Fax:325-597-2155
Is Sole Proprietor?:No
Enumeration Date:2005-12-19
Last Update Date:2015-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA00059363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant