Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Mrs. Allyssa Mae Kittock, PA

Individual provider Physician Assistant · NPI 1902203045

Mrs. Allyssa Mae Kittock, PA is a Physician Assistant in St Louis Park, Minnesota. Qualified in 2014, 12 years ago. Practices with Park Nicollet Clinic, a 1,773-clinician group, accepts Medicare assignment and offers telehealth.

Years since qualifying
12
In the registry since
2014
What do these letters mean?
PA — Physician Assistant
A licensed clinician who examines, diagnoses and treats under a physician's supervision.

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Practice location Address checks out

5400 Excelsior Blvd
St Louis Park, MN 55416-2913
Phone: (952) 993-1000
Fax: (952) 993-1160
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Physician Assistant (primary) Taxonomy 363A00000X

Record details

NPI number1902203045
Entity typeIndividual (Type 1)
GenderFemale
Credentials PA
Sole proprietorNo
NPI enumeratedDecember 3, 2014
Last updated in NPPESJune 29, 2022
Certification dateJune 29, 2022

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyPHYSICIAN ASSISTANT
Medical schoolOTHER
Graduated 2014 (12 years in practice)
Group practice Park Nicollet Clinic — 1773 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
TelehealthOffers telehealth services
Practice locations10 on file with Medicare

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