Healthcare Provider Details

I. General information

NPI: 1770749624
Provider Name (Legal Business Name): TIFFANY LEIGH KIDD DNP,PNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/30/2008
Last Update Date: 06/21/2022
Certification Date: 06/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1901 TATE SPRINGS RD
LYNCHBURG VA
24501-1109
US

IV. Provider business mailing address

1901 TATE SPRINGS RD
LYNCHBURG VA
24501-1109
US

V. Phone/Fax

Practice location:
  • Phone: 434-200-3656
  • Fax: 434-200-3650
Mailing address:
  • Phone: 434-200-3656
  • Fax: 434-200-3650

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number0024167929
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: