Healthcare Provider Details

I. General information

NPI: 1861639015
Provider Name (Legal Business Name): KATHERINE B KIDD FNP, BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/09/2009
Last Update Date: 04/13/2026
Certification Date: 04/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8288 FIRETOWER RD STE F
PASS CHRISTIAN MS
39571-9621
US

IV. Provider business mailing address

2074 SCIANNA LN
BAY SAINT LOUIS MS
39520-1653
US

V. Phone/Fax

Practice location:
  • Phone: 228-222-8900
  • Fax: 228-222-8906
Mailing address:
  • Phone: 662-251-6205
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR830346
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: