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NPI Code Detail

MEDICARE: ABIGAIL KIDDER

MEDICARE: ABIGAIL KIDDER
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
1172V00000XCommunity Health Worker
2171M00000XCase Manager/Care CoordinatorOH
3390200000XStudent in an Organized Health Care Education/Training Program

General Provider Information

NPI Number : 1306671656
Entity Type Code : Individual
Provider Name (Legal Business Name) : ABIGAIL KIDDER
Provider Business Mailing Address
First Line : 727 MARTIN LUTHER KING DR W
Second Line :
City : CINCINNATI
State : OH
Zip : 45220-2572
Country : US
Telephone Number : 937-750-1338
Fax Number :
Provider Business Practice Location Address
First Line : 4721 READING RD
Second Line :
City : CINCINNATI
State : OH
Zip : 45237-6107
Country : US
Telephone Number : 855-577-7284
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/05/2024
Last Update Date : 05/15/2026

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