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General NPI Number Information
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NPI Number | 1649365289
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Entity Type | Individual
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Provider Name | MARY ANNE KIDWELL PA-C
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Gender | Female
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Dates
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Enumeration Date | 10/03/2006
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Last Update Date | 01/24/2025
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Provider Practice Location Address
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Address Line | 5352 LINTON BLVD
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City | DELRAY BEACH
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State | FL
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Zip | 33484-6514
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Country | US
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Telephone | 561-498-4440
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Fax |
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Provider Business Mailing Address
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Address Line | 5190 LAS VERDES CIR APT 212
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City | DELRAY BEACH
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State | FL
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Zip | 33484-8048
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Country | US
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Telephone | 702-332-4191
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA839
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License Number State | NV
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 1537
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License Number State | SD
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Taxonomy #3
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | PA839
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License Number State | NV
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Taxonomy #4
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 9118662
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License Number State | FL
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