Healthcare Provider Details

I. General information

NPI: 1982243937
Provider Name (Legal Business Name): TONNESHA KIDD PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/22/2019
Last Update Date: 07/17/2023
Certification Date: 07/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1676 N OLDEN AVE BLDG 1
EWING NJ
08638-3210
US

IV. Provider business mailing address

PO BOX 33113
TRENTON NJ
08629-3113
US

V. Phone/Fax

Practice location:
  • Phone: 180-093-1802
  • Fax: 609-631-5130
Mailing address:
  • Phone: 800-931-8026
  • Fax: 609-631-5130

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number26NJ01067200
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: