Basic Information
| Provider Information | |||||||||
| NPI: | 1326017161 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KITCHEN | ||||||||
| FirstName: | JOHN | ||||||||
| MiddleName: | ROBERT | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | R.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | USA MEDDAC, EVANS ARMY COMMUNITY HOSPITAL | ||||||||
| Address2: | 1650 COCHRANE CIRCLE: ATTN CREDENTIALS OFFICE | ||||||||
| City: | FORT CARSON | ||||||||
| State: | CO | ||||||||
| PostalCode: | 809134604 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7195267844 | ||||||||
| FaxNumber: | 7195267984 | ||||||||
| Practice Location | |||||||||
| Address1: | USA MEDDAC, EVANS ARMY COMMUNITY HOSPTIAL | ||||||||
| Address2: | 1650 COCHRANE CIRCLE: ATTN: NUTRITION CARE DIVISION | ||||||||
| City: | FORT CARSON | ||||||||
| State: | CO | ||||||||
| PostalCode: | 809134604 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7195267968 | ||||||||
| FaxNumber: | 7195267586 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/15/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | X | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 133N00000X | 001459-1 | NY | Y | Dietary & Nutritional Service Providers | Nutritionist |
No ID Information.