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General NPI Number Information
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NPI Number | 1780992289
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Entity Type | Individual
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Provider Name | JAMESETTA WILLIAMS KIDD
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Gender | Female
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Dates
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Enumeration Date | 09/17/2010
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Last Update Date | 09/17/2010
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Provider Practice Location Address
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Address Line | 324 GENTRY ST
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City | SPRING
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State | TX
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Zip | 77373-8316
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Country | US
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Telephone | 832-797-6589
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Fax | 281-583-8527
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Provider Business Mailing Address
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Address Line | 1514 BODART DR
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City | HOUSTON
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State | TX
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Zip | 77090-2406
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Country | US
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Telephone | 832-797-6589
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Fax | 281-583-8537
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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 | 211D00000X
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Taxonomy Name | Podiatric Assistant
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License Number |
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License Number State |
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