Individual
JACOB KIDWELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
5267 BRASS LANTERN PL, SAINT LOUIS, MO 63128-3501
(314) 347-9769
Mailing address
5267 BRASS LANTERN PL, SAINT LOUIS, MO 63128-3501
(314) 347-9769
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
—
—
Other
Enumeration date
04/28/2025
Last updated
04/28/2025
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