Healthcare Provider Details

I. General information

NPI: 1225867328
Provider Name (Legal Business Name): CHRISTINA MARIE KIDD CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: CHRISTINA MARIE DICKERSON

II. Dates (important events)

Enumeration Date: 07/29/2024
Last Update Date: 08/11/2026
Certification Date: 08/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2817 ROCK MERRITT AVE WOMACK ARMY MEDICAL CENTER
FORT BRAGG NC
28310-0001
US

IV. Provider business mailing address

2817 ROCK MERRITT AVE WOMACK ARMY MEDICAL CENTER
FORT BRAGG NC
28310-0001
US

V. Phone/Fax

Practice location:
  • Phone: 240-215-7582
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number149312
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: