Individual
LAURA R KIDD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
P.A.
Contact information
Practice address
305 W JACKSON ST STE 200, CARBONDALE, IL 62901-1474
(618) 536-6621
(618) 453-1102
Mailing address
305 W JACKSON ST STE 200, CARBONDALE, IL 62901-1474
(618) 536-6621
(618) 453-1102
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
085.002750
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
085-002750
PHYSICIAN ASSISTANT LICENSE
IL
Enumeration date
09/20/2006
Last updated
07/21/2022
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