Provider Demographics
NPI:1306610654
Name:KITCH, EMILY (NURSE PRACTITIONER)
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:
Last Name:KITCH
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1682 S SAINT ANDREWS RD E
Mailing Address - Street 2:
Mailing Address - City:WINONA LAKE
Mailing Address - State:IN
Mailing Address - Zip Code:46590-8918
Mailing Address - Country:US
Mailing Address - Phone:574-343-3086
Mailing Address - Fax:
Practice Address - Street 1:400 W LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:GOSHEN
Practice Address - State:IN
Practice Address - Zip Code:46526-2413
Practice Address - Country:US
Practice Address - Phone:474-457-4534
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-07
Last Update Date:2023-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71014510A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily