Provider Demographics
NPI:1164313847
Name:KITTRIDGE, NATHAN
Entity type:Individual
Prefix:MR
First Name:NATHAN
Middle Name:
Last Name:KITTRIDGE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9218 CHEROKEE LN
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37027-7405
Mailing Address - Country:US
Mailing Address - Phone:603-616-3156
Mailing Address - Fax:
Practice Address - Street 1:9218 CHEROKEE LN
Practice Address - Street 2:
Practice Address - City:BRENTWOOD
Practice Address - State:TN
Practice Address - Zip Code:37027-7405
Practice Address - Country:US
Practice Address - Phone:603-616-3156
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-11
Last Update Date:2025-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1001103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst