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General NPI Number Information
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NPI Number | 1861809998
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Entity Type | Individual
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Provider Name | KATHERINE KELLY LIDZ ARNP
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Gender | Female
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Dates
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Enumeration Date | 07/21/2014
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Last Update Date | 05/05/2025
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Provider Practice Location Address
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Address Line | 6520 SW THISTLE TER
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City | PALM CITY
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State | FL
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Zip | 34990-3857
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Country | US
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Telephone | 803-619-9846
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Fax |
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Provider Business Mailing Address
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Address Line | 1983 NEWBERRY LN
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City | TEGA CAY
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State | SC
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Zip | 29708-8438
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Country | US
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Telephone | 803-619-9846
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Fax | 803-913-5275
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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 | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | ARNP9424269
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 163WP0808X
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Taxonomy Name | Psychiatric/Mental Health Registered Nurse
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License Number | RN9424269
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License Number State | FL
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