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NPI Code Detail

MEDICARE: NIKOLE KIDD

MEDICARE: NIKOLE 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
13747P1801XPersonal Care Attendant
2101YA0400XAddiction (Substance Use Disorder) Counselor

General Provider Information

NPI Number : 1790351575
Entity Type Code : Individual
Provider Name (Legal Business Name) : NIKOLE KIDD
Provider Business Mailing Address
First Line : 425 JULIANA ST
Second Line :
City : PARKERSBURG
State : WV
Zip : 26101-5352
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 425 JULIANA ST
Second Line :
City : PARKERSBURG
State : WV
Zip : 26101-5352
Country : US
Telephone Number : 304-893-9777
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/02/2021
Last Update Date : 06/02/2025

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Directions to “ NIKOLE KIDD ” Practice Location

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