Individual
MS. JEANIE MARIE KITTLESON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
ST ROSE DOMINICAN DE LIMA, 102 E LAKE MEAD PKWY, HENDERSON, NV 89015
(702) 616-4600
(702) 616-4311
Mailing address
237 HANLEY WAY, HENDERSON, NV 89074-5387
(252) 258-2164
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA833
NV
363AM0700X
Medical Physician Assistant
PA833
NV
363AM0700X
Medical Physician Assistant
PA9114559
FL
363AS0400X
Surgical Physician Assistant
PA833
NV
363AS0400X
Surgical Physician Assistant
—
NV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100503035
—
NV
Enumeration date
02/27/2007
Last updated
08/31/2021
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