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General NPI Number Information
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NPI Number | 1811168941
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Entity Type | Individual
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Provider Name | KEITH L KIDD FNP-BC
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Gender | Male
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Dates
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Enumeration Date | 03/17/2008
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Last Update Date | 10/29/2021
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Provider Practice Location Address
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Address Line | 9026 HIWASSEE ST NE
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City | CHARLESTON
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State | TN
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Zip | 37310-5305
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Country | US
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Telephone | 423-665-3666
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Fax | 423-584-6747
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Provider Business Mailing Address
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Address Line | PO BOX 15
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City | CHARLESTON
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State | TN
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Zip | 37310-0015
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Country | US
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Telephone | 423-665-3666
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Fax | 423-584-6747
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 13254
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License Number State | TN
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