Active NPI
Karen Kittlesen, PHYSICIAN ASSISTANT
- Physician Assistant
- Fort Stewart, GA
National Provider Identifier
1255567525
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- 1086058
- Practice address
- 1061 Harmon Avenue
Building 412
Fort Stewart, GA 31314-5674 - Phone
- (912) 435-5539
- Fax
- (912) 435-5674
- NPI assigned
- Jun 1, 2009
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 1086058 | GA | Primary |
Addresses
Primary practice location
1061 Harmon Avenue
Building 412
Fort Stewart, GA 31314-5674
Mailing address
1061 Harmon Avenue
Building 412
Fort Stewart, GA 31314-5674
Phone (912) 435-5539
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1086058 | GA | MD | Physician Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1243814400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1294790400000",
"number": "1255567525",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1061 HARMON AVENUE",
"address_2": "BUILDING 412",
"city": "FORT STEWART",
"state": "GA",
"postal_code": "313145674",
"telephone_number": "912-435-5539",
"fax_number": "912-435-5674"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1061 HARMON AVENUE",
"address_2": "BUILDING 412",
"city": "FORT STEWART",
"state": "GA",
"postal_code": "313145674",
"telephone_number": "912-435-5539",
"fax_number": "912-435-5674"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KITTLESEN",
"first_name": "KAREN",
"credential": "PHYSICIAN ASSISTANT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2009-06-01",
"last_updated": "2011-01-12",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "GA",
"license": "1086058",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fort Stewart, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 12, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.