Healthcare Provider Details

I. General information

NPI: 1174936009
Provider Name (Legal Business Name): JENNIFER KIDD ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2014
Last Update Date: 02/10/2026
Certification Date: 02/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1324 WOLF PARK DR
GERMANTOWN TN
38138-1741
US

IV. Provider business mailing address

PO BOX 381468
GERMANTOWN TN
38183-1468
US

V. Phone/Fax

Practice location:
  • Phone: 901-755-9110
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number24248
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: