Provider Demographics
NPI:1588991913
Name:KITCHENS, CATHERINE HEATHER (PA-C)
Entity type:Individual
Prefix:MRS
First Name:CATHERINE
Middle Name:HEATHER
Last Name:KITCHENS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MISS
Other - First Name:CATHERINE
Other - Middle Name:HEATHER
Other - Last Name:QUEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:820 SAINT SEBASTIAN WAY STE 6C
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30901-2640
Mailing Address - Country:US
Mailing Address - Phone:706-722-4280
Mailing Address - Fax:706-722-4298
Practice Address - Street 1:820 SAINT SEBASTIAN WAY STE 6C
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30901-2640
Practice Address - Country:US
Practice Address - Phone:706-722-4280
Practice Address - Fax:706-722-4298
Is Sole Proprietor?:No
Enumeration Date:2009-11-05
Last Update Date:2009-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALP20084Medicare UPIN