Individual
JASON S. KIDD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
924 LIBERTY STREET, WEST MILFORD, WV 26451
(304) 745-4568
(304) 326-3700
Mailing address
PO BOX 217, ROCK CAVE, WV 26234-0217
(304) 924-6262
(304) 924-5460
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
01023
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3810010365
—
WV
Enumeration date
04/12/2007
Last updated
07/16/2013
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