Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | 46301082340 | MI |
N | 2080P0207X | Pediatric Hematology-Oncologist | 46301082340 | MI |
Y | 2080P0207X | Pediatric Hematology-Oncologist | MD52818 | TN |
NPI | 1205912177 |
---|---|
Provider Name | Carrie L Kitko |
First Address | Nashville, TN 37232-5100 |
Second Address | Nashville, TN 37232-5100 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/10/2006 |
Last Update Date | 15/10/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
H67733 | (02) | MI |