Individual
MONA KIDWELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
N.P.
Contact information
Practice address
2785 GULF FWY S, SUITE 115, LEAGUE CITY, TX 77573-4979
(832) 816-1370
Mailing address
2785 GULF FWY S, SUITE 115, LEAGUE CITY, TX 77573-4979
(832) 816-1370
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
Primary
508280
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2035487-02
—
TX
05
—
3031130-01
—
TX
01
—
88N956
BCBS
TX
01
—
P01095012
RAIL ROAD MEDICARE
TX
Enumeration date
06/04/2012
Last updated
06/07/2015
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