Jack Bartlett Kistler, MD

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

C26186 Issued in CA

Practice address

6900 Brockton Ave
Ste 11
Riverside, CA 92506

Phone

(951) 682-6263

Fax

(951) 682-0114

NPI assigned

Sep 7, 2006

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1157587200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1356444996",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6900 BROCKTON AVE",
            "address_2": "STE 11",
            "city": "RIVERSIDE",
            "state": "CA",
            "postal_code": "92506",
            "telephone_number": "951-682-6263",
            "fax_number": "951-682-0114"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6900 BROCKTON AVE",
            "address_2": "STE 11",
            "city": "RIVERSIDE",
            "state": "CA",
            "postal_code": "92506",
            "telephone_number": "951-682-6263",
            "fax_number": "951-682-0114"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KISTLER",
        "first_name": "JACK",
        "middle_name": "BARTLETT",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-09-07",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "CA",
            "license": "C26186",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Judith Merrill Kircher, MFT
• Nathalie Kirshman, MD
• Sara Grace Kish
• Katherine Hart Kishino, M.S.
• Nancy Daubert Kishino, OT
• Danielle D Kitchen
• Mylie Kizler
• Melani Klapp
• Allison Klecker, MA,SLP-CCC
• Hannah Klein

• Family Medicine Physician in Riverside, CA
• Providers in Riverside, CA by specialty
• Family Medicine Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.