Provider Demographics
NPI:1932392248
Name:KITSON, JUDY DIANE (FNP- BC)
Entity Type:Individual
Prefix:
First Name:JUDY
Middle Name:DIANE
Last Name:KITSON
Suffix:
Gender:F
Credentials:FNP- BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7405 SHALLOWFORD RD
Mailing Address - Street 2:SUITE 160
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37421-2661
Mailing Address - Country:US
Mailing Address - Phone:423-899-1000
Mailing Address - Fax:
Practice Address - Street 1:7405 SHALLOWFORD RD
Practice Address - Street 2:SUITE 160
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37421-2661
Practice Address - Country:US
Practice Address - Phone:423-899-1000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-20
Last Update Date:2015-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN12852363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN103I506926Medicare PIN
TN33413441Medicare PIN