Healthcare Provider Details

I. General information

NPI: 1114706207
Provider Name (Legal Business Name): ANDIE KIDA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ANDIE KIDA DNP, FNP-BC, RD

II. Dates (important events)

Enumeration Date: 09/27/2023
Last Update Date: 10/17/2024
Certification Date: 10/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

970 N KALAHEO AVE STE C306
KAILUA HI
96734-1873
US

IV. Provider business mailing address

970 N KALAHEO AVE STE C306
KAILUA HI
96734-1873
US

V. Phone/Fax

Practice location:
  • Phone: 808-263-7383
  • Fax:
Mailing address:
  • Phone: 808-263-7383
  • Fax: 808-327-5828

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number86065727
License Number StateHI
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number99400
License Number StateHI
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN-4259-0
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: