1508963299 NPI number — JACQUELIN RANDY KITSON RN, NP, BC

Table of content: JACQUELIN RANDY KITSON RN, NP, BC (NPI 1508963299)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1508963299 NPI number — JACQUELIN RANDY KITSON RN, NP, BC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KITSON
Provider First Name:
JACQUELIN
Provider Middle Name:
RANDY
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
RN, NP, BC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
DICHTER
Provider Other First Name:
JACQUELIN
Provider Other Middle Name:
RANDY
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
RN, NP, BC
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1508963299
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/20/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
174 WALTER HAYS DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PALO ALTO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
94303-2923
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
408-410-1608
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
270 INTERNATIONAL CIR
Provider Second Line Business Practice Location Address:
2 NORTH
Provider Business Practice Location Address City Name:
SAN JOSE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95119-1130
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
408-363-4968
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/17/2006

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: 363LF0000X , with the licence number:  546807 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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