Individual
JASON W KIDD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
ARPN
Contact information
Practice address
104 HIGHWAY 15 N, NEW ALBANY, MS 38652-5313
(662) 486-2124
Mailing address
417 RAY ST, NEW ALBANY, MS 38652-1914
(662) 266-5464
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
894920
MS
Other
Enumeration date
09/14/2020
Last updated
09/14/2020
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