Active NPI
Nicole Ann Kitchen, PA
- Physician Assistant
- San Diego, CA
National Provider Identifier
1407237522
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- 57023
- Practice address
- 8010 Frost St FL 2
San Diego, CA 92123-4284 - Phone
- (858) 939-8350
- NPI assigned
- Jun 15, 2015
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | PA-109 | GU | |
| Physician Assistant | 363A00000X | 57023 | CA | Primary |
Addresses
Primary practice location
8010 Frost St FL 2
San Diego, CA 92123-4284
Mailing address
8010 Frost St FL 2
San Diego, CA 92123-4284
Phone (589) 398-3508
Other names 1
- Nicole Ann Amezquita
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in VA
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: No
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Physician Assistant
- Education
- Eastern Virginia Medical School, 2015
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
Practice addresses (Care Compare)
150 Kingsley LN
Norfolk, VA 23505-4602
Phone (757) 398-2673
3636 High St
Portsmouth, VA 23707-3236
Phone (757) 398-2222
Hospital & facility affiliations
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PA-109 | GU | MD | Physician Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Bon Secours Medical Group Hampton Roads Specialty Care LLC | Current | Accepting new patients | |
| Bon Secours Medical Group Hampton Roads Specialty Care LLC | Current | Accepting new patients |
Locations
150 Kingsley Ln
Norfolk, VA 23505
Phone (757) 464-6944
1040 University Blvd
Ste 205
Portsmouth, VA 23703
Phone (757) 484-2272
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Cardiovascular Disease Physician
- Richmond, VA
- NPI 1629637475
-
- Durable Medical Equipment & Medical Supplies
- Franklin, VA
- NPI 1205451028
Hospital & facility affiliations 9
Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.
-
- General Acute Care Hospital
- Portsmouth, VA
- NPI 1750399192
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1434326400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1602547200000",
"number": "1407237522",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "8010 FROST ST FL 2",
"city": "SAN DIEGO",
"state": "CA",
"postal_code": "921234284",
"telephone_number": "589-398-3508"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "8010 FROST ST FL 2",
"city": "SAN DIEGO",
"state": "CA",
"postal_code": "921234284",
"telephone_number": "858-939-8350"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KITCHEN",
"first_name": "NICOLE",
"middle_name": "ANN",
"credential": "PA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2015-06-15",
"last_updated": "2020-10-13",
"certification_date": "2020-10-13",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "GU",
"license": "PA-109",
"primary": false
},
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "CA",
"license": "57023",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"first_name": "NICOLE",
"last_name": "AMEZQUITA",
"middle_name": "ANN",
"code": "1",
"type": "Former Name"
}
]
}Other providers in San Diego, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 13, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.