Healthcare Provider Details

I. General information

NPI: 1518978857
Provider Name (Legal Business Name): NANCY N KIDD RNFA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/11/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7200 WYOMING SPGS SUITE 300
ROUND ROCK TX
78681-4303
US

IV. Provider business mailing address

7200 WYOMING SPGS STE 300
ROUND ROCK TX
78681-4304
US

V. Phone/Fax

Practice location:
  • Phone: 512-244-3755
  • Fax: 512-244-9318
Mailing address:
  • Phone: 512-244-3755
  • Fax: 512-244-9318

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0121X
TaxonomyPlastic Surgery Registered Nurse
License Number236907
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: