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NPI Code Detail

MEDICARE: KURTIS KIDD

MEDICARE: KURTIS KIDD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
12255A2300XAthletic TrainerAT-AT-660031OR

General Provider Information

NPI Number : 1245655380
Entity Type Code : Individual
Provider Name (Legal Business Name) : KURTIS KIDD
Provider Business Mailing Address
First Line : 345 MONMOUTH AVE N
Second Line :
City : MONMOUTH
State : OR
Zip : 97361-1329
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 345 MONMOUTH AVE N
Second Line :
City : MONMOUTH
State : OR
Zip : 97361-1329
Country : US
Telephone Number : 503-838-8343
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/26/2014
Last Update Date : 02/26/2014

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Directions to “ KURTIS KIDD ” Practice Location

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