Individual provider Active NPI

Christina Moran Kitchen, FNP

  • Family Nurse Practitioner
  • Jackson, WY
National Provider Identifier
1679742258
Registry record updated Apr 14, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
24423.0895 Issued in WY
Practice address
555 E Broadway Ave
Suite 108
Jackson, WY 83001-8640
Phone
(307) 734-1005
Fax
(307) 734-1165
NPI assigned
Feb 27, 2008
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 14, 2015

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 24423.0895 WY Primary

Addresses

Primary practice location

555 E Broadway Ave
Suite 108
Jackson, WY 83001-8640

Mailing address

PO Box 3306
Idaho Falls, ID 83403-3306
Phone (307) 734-1201

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WY
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20080818000253 WY Practitioner - Nurse Practitioner 1254406895 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2006
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Gros Ventre OB-GYN LLPGroup PAC ID 2466541693, 4 clinicians

Practice addresses (Care Compare)

555 E Broadway
Suite 108
Jackson, WY 83001-5550
Phone (307) 734-1005

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Gros Ventre OB/GYN, LLP CurrentSince Mar 1, 2008 Accepting new patients

Interoperability endpoints

  • FHIR API: https://fhir-myrecord.cerner.com/r4/4ea2101b-bb2d-4211-bc53-3120cb72bcc5/

Organizations & group practices 1

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.

Hospital & facility affiliations 1

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1204070400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1428969600000",
    "number": "1679742258",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 3306",
            "city": "IDAHO FALLS",
            "state": "ID",
            "postal_code": "834033306",
            "telephone_number": "307-734-1201",
            "fax_number": "307-734-1165"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "555 E BROADWAY AVE",
            "address_2": "SUITE 108",
            "city": "JACKSON",
            "state": "WY",
            "postal_code": "830018640",
            "telephone_number": "307-734-1005",
            "fax_number": "307-734-1165"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KITCHEN",
        "first_name": "CHRISTINA",
        "middle_name": "MORAN",
        "credential": "FNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-02-27",
        "last_updated": "2015-04-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "WY",
            "license": "24423.0895",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Jackson, WY

Sources for this page

Verify at the official NPI Registry.