Provider Demographics
NPI:1891879706
Name:MCKITTRICK, JOHN MASON
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:MASON
Last Name:MCKITTRICK
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 1:1180 N TOWN CENTER DR STE 100
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89144-6308
Mailing Address - Country:US
Mailing Address - Phone:702-202-2060
Mailing Address - Fax:702-605-2892
Practice Address - Street 1:1180 N TOWN CENTER DR STE 100
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89144-6308
Practice Address - Country:US
Practice Address - Phone:702-202-2060
Practice Address - Fax:702-605-2892
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2024-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVDO2382207QH0002X, 207Q00000X
NVB-905111N00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Yes207QH0002XAllopathic & Osteopathic PhysiciansFamily MedicineHospice and Palliative Medicine
No111N00000XChiropractic ProvidersChiropractor
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAU89823Medicare UPIN
CAU89823Medicare UPIN