1710642558 NPI number — MR. JODY GLENN KITTLE MSN, APRN, PMHNP-BC

Table of content: MR. JODY GLENN KITTLE MSN, APRN, PMHNP-BC (NPI 1710642558)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1710642558 NPI number — MR. JODY GLENN KITTLE MSN, APRN, PMHNP-BC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KITTLE
Provider First Name:
JODY
Provider Middle Name:
GLENN
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
MSN, APRN, PMHNP-BC
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
KITTLE
Provider Other First Name:
JODY
Provider Other Middle Name:
GLENN
Provider Other Name Prefix Text:
MR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
MSN, APRN, PMHNP-BC
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1710642558
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/26/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2201 OAKLEAF CT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FRANKLIN
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37064-7409
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
615-974-3103
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1909 MALLORY LN STE 200
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FRANKLIN
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37067-2842
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
615-771-1100
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/06/2021

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LP0808X , with the licence number:  32758 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 163W00000X , with the licence number: 239979 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)