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General NPI Number Information
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NPI Number | 1891147849
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Entity Type | Individual
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Provider Name | CRAIG MATTHEW KIDDER I MSHSA, ANP-C, RHIA
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Gender | Male
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Dates
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Enumeration Date | 07/01/2016
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Last Update Date | 05/28/2021
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Provider Practice Location Address
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Address Line | 1302 ED BROUSSARD
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City | NEW IBERIA
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State | LA
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Zip | 70563-7056
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Country | US
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Telephone | 337-229-7929
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Fax |
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Provider Business Mailing Address
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Address Line | 600 DON GUILBEAU RD
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City | ARNAUDVILLE
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State | LA
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Zip | 70512-6440
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Country | US
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Telephone | 337-351-7114
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | AP08726
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License Number State | LA
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