Provider Demographics
NPI:1023844560
Name:KITCHEN, JODI S
Entity type:Individual
Prefix:
First Name:JODI
Middle Name:S
Last Name:KITCHEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1301 W STEWART AVE UNIT 1
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97501-4705
Mailing Address - Country:US
Mailing Address - Phone:541-261-8061
Mailing Address - Fax:
Practice Address - Street 1:1301 W STEWART AVE UNIT 1
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97501-4705
Practice Address - Country:US
Practice Address - Phone:541-261-8061
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-11
Last Update Date:2024-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide