Healthcare Provider Details

I. General information

NPI: 1174885669
Provider Name (Legal Business Name): LAURA ROBINSON KIDD M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LAURA MARIE ROBINSON M.D.

II. Dates (important events)

Enumeration Date: 06/12/2012
Last Update Date: 07/15/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

503 MCMILLAN RD
WEST MONROE LA
71291
US

IV. Provider business mailing address

PO BOX 3780
TUPELO MS
38803-3780
US

V. Phone/Fax

Practice location:
  • Phone: 318-329-8830
  • Fax:
Mailing address:
  • Phone: 318-841-9526
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License NumberBP20044135
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License NumberP5395
License Number StateTX
# 3
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License NumberMD.206962
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: